91-1843������,,, r /„
� Council File # / ' ���'�
L ;
Green sheet #� 6134
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
� r
Presented By
Referred To Committee: Date
SAINT PAUL BOARD OF HSALTH
WHERBAS, the City of Saint Paul throu�h its Division of Public
Health is required bp Statue to prepare a Community Health Services
Plan to receive a Community Health Services Subsidy: and
WHTREAS, this plan for 1991-1995 was completed jointly by the St.
Paul - 8amsey County Community Health Services Advisory Committee,
The St. Paul Division of Public Health and the ftamsey County Public
Health Department; and
WH£sREAS, this plan was presented for public comment and the changes
recommended by the public have been incorporated into the plan; and
WH£REAS, the 1992-1993 Indian Health Grant for St. Paul and
Suburban Ramsey County is .submitted to the Minnesota Department of
Health by the St. Paul Division of Public Health and contained in
the Community Health Services Plan; and
WHBREAS, this plan must be approved by the City Council as the
Board of Health;
THEftEFORE, BE IT RESOLVED, that the City Council sittin� as the
Board of Health does accept the St. Paul - Ramsey County Community
Health Services Plan for 1991 - 1995, and the Indian Health Grant
for 1992-1993 for St. Paul and Suburban Ramsey County for
submission to Ramsep County Board for their approval and
transmission to the Minnesota Commissioner of Health.
Yeas l�ava Absent Requested by Department of:
s''' T Communi ty S rv' es
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n e i 8 ,c�-
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` _
Adopted by Council: Date 0 CT 1 0 1991 Form A roved by City Attorney
Adoption Ce ifie by Counc S cretary By: �, _
BY= Approved by Mayor for S bmission to
Approved by May rs Date 0 C� � 5 1991 Counc3l
g s a��� By: .��iGi�wti�fil
Y
P�AU�lED OCT 19�31
. i 9����,�
OEPMTM[NT/OFFICE/COUNqI DATE INIT�ATED
�.s./Pub�i c Heal th 9-�0-91 REEN SH�ET No. 6� ��
C�ITACT PERSON 8 P IN U DATE INITIAUDATE
� OEPARiMENT aRECTOR I GTY COUNdL
Di ane Holm ren 292-7712 � �� �rr�N� � g c��v c��c
MUST BE ON OOUNpL AOENDA 8Y(DATE) iqllTlNp DOET DIRECTOR � FIN.8 MOT.SERVICE8 DIR.
�YOR(OR A88181'A-T LJ
TOTAL�OF 81ONATURE PAC,+E$ ], (CLIP ALt LOCATIONS FOR SIGNATUR� ��
ACTION HEGUESTED:
City signatures on a Resolution for Board of Health approval of� the 1992 - 1995 St_. Paul -
Ramsey County Comnunity Health Services (CHS) Plan and the 1992i - 1993 Indian Health Grant
for St. Paul & Suburban Ramsey County.
REOOMMENDATIONB:MP►ove(A)a R�1�� C011NqL RCN I�PORT OP AL
_PLANNIPKi COMMI8310N _GVIL SERVI(�OOMMISSION ��YST PHONE N0.
_CIB COMMITTEE _
—�"� — �"�: ,�..- SEP i1 1991
—����� _ ��"- i
SUPPORTS WHICH COUPIdL OBJECTIVEI �
� CITY ATTORNEY
INITIATINO PROBLEM,188UE.OPPORTUNIIY(Who,VYh�t,Wh�n.1NMro.Why):
The City of St. Paul , though the .Division.of Public Health is r quired by statute to prepare
a Comnunity Health Services Plan to receive a Community Flealth ervices Subsidy. This plan
must be approved by the St. Paul Board of Health. Also, the St. Pau1 Division of Public
Health is submitting a grant for Indian Edealth Services to St. aul & Suburban P.arasey County
American Indians. This grant, included in the CHS Plan, also mt�st be approved by the S�. Paul
6oard of Health. �
II
ADVANTA(iES IF APPROVED:
.The City will receive approximately $945,865 in funding annual y for comnunity health servic s.
.In 1992, $119,647 of State funding will be available for servi�es to St. Paul and Suburban
Ramsey County �American Indians. In 1993 this amount will be $�22,989.
I
I
°'�"°�"►�"°E$'F"�°: RECEIVED I
r�or�E
SEP 2 6 1991 � R�CE�vED
CITY CLERK j SEP 2 0 1991
� �
MAYOR'S OFFICf
D18ADVANTAOEB IF NOT APPROVED:
.The City, through the Division of Public Nealth will not receive the above mentioned funding
for community health services. '
.State funds for health services to St. Paul and Ramsey County A I ri 11 � ���be
avai 1 abl e. �D''�� �° �G�n �����'';y
� SEP 2 3 1991
TOTAL AMOUNT OF TRANSACTION a 4��42,096 COST/REVENUE SI�#TED E ON� YES NO
1 I� State of Minnesota Va ious
FUNOINO SOURCE ACTIVITY NUMBER
� FlNANqAL INFORMATION:(EXPWN) I
i
i � dW
�
� .
. > �
t� � � �
NOTE: COMPLETE DIRECTIONS ARE INa.UDED IN THE OREEN SMEET IN8TRUCTIONAL
MANUAL AVAILABI.E IN THE PURCHASINii OFFICE(PNONE NO.298-4225).
ROUTIN(i ORDER:
Bslow are preferred routi�tor the flve most frequsM typss of documsnts:
CONTRACTS (s�sumss wtiwrized COUNqL RE30LUTIONI (Amsnd, BdgtsJ
budgst exiets) �°►ccePt.(3rants)
1. Outaide Agsncy � 1. DepeutmeM DireCtor
2. IMdeting Dspartment 2. Budgst Director
3. Gty Attomey 3. Cky Attornsy
4. Mayor 4. MayoNHasistaM
5. Flnar�ce�Mgmt Svcs. Dirsctor 5. (:ity Coundl ;
6. F'inance AcoouMin� 8: Chief Aa:ountaM, Fin 8 Mgmt Svcs.
ADMINISTRATIVE ORDER �, COUNqL RESOLUTION (�����
i. �►ccivtiy n�ana9sr 1. Initiatinp DepaRment Director
2. Dspartmsnt AocounteM 2. City Attornsy
3. DepaRmsnt Director 3. Maya'/Aqistant
4. Bud�e�t Diroctor 4. Ciiy Couticil
5. City Gerk
8. Chief AxouMent, Fin&Mgmt Svcs.
ADMINISTRA7'IVE ORDERS (all othsrs)
1, Inidatinp DspertmeM
2. Gty Attorney
3. MayoNAssistant
4. dty Clerk '
TOTAL NUMBER OF SK3NATURE PA(3E3
Indicate the i of pepss on which sbnstures are roquired and�
esch of theee�
ACTION RE(�UESTED
Dsec�ib�what ths proJscf/request seeks to aocamptish fn eithK chronoloqi-
cal ordsr or o�r of ImpoRSnce�whichsver ia most appropriate for the
issue.Do not w�ite complete s�nteixbs. 8spin each Rem in your list with
a verb.
RECOMMEN�ATIONS
Complete H the i�w 1n qusstion hes bssn preasMsd before any body.Public
w private.
3UPPORTS WHICH OOUNqI OBJECTIVE?
Indfceto which Cwmcil obJectN►�(a)your projscUreque�supports by listing
ths key word(s)(HOUSINti, REqiEATION,NEKiHBORHOOOS, ECONOMIC DEVELOPMENT,
BUD(iET,SEWER 3EPARATION). (SEE COAAPLETE UST IN IN3TRUCTIONAL MANUAL.)
COUNCIL OONIMITTEEIRE8EARCH REPORT-OPTIONAL AS RE�UESTED BY COUNCIL
INITIATINCi PROBLEM, ISSUE,OPPORTUNITY '
Explai�the situation a conditione ttu�t crsated a need for Y��P�
a request.
' ADVANTAtdES IF MPROVED
Indicsts wh�thsr this is timply an annual bud�et procedure requfred by law/
chertsr or whethsr tMro are spedflc wa in wh�h the qty of SetM Peul
and tts cRizens wlll bsnsflt from this pro�sct/actbn.
DISADVANTAOES IF APPAOVED
What nepatHe effects a major chan�es to exlating or past processea might
thfs proJecUrequsst producs if it is p�a�d(e.�.,traHic delaya, noise,
tax incrs�ses or assassments)4 To Whom?Whsn7 Fo►hovn Iong7
DISADVANTACiES IF NOT APPROVED
What will be the neqeitive conaequencss H the promieed action is not
appraved?InaWliy to dsliver aervice?Continued hiph traf8c, noise,
acCideM fatA4 LOef Of rewnlM7
FINANqAL IMPACT
Althoiqh you muet tailor the information you provide hers to the iseue you
aro addreesing, in gensral you murt answer two qu�tions: Hc�v much is it �
qqing to cost?Who is gofng to pey?
�-y�- ���`
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� CITY OF SAINT PAUL
iiii�i ssgii
�' OFFICE OF THE CITY COUNCIL
PAULA MACCABEE susarv ooe
Councilmember Legislative Aide
, Members:
• Paula Maccabee, Chair
Bob Long
Janice Rettman
Date: October 9, 1991
COMMITTEE REPORT
HUMAN SERVICES, REGULATED INDUSTRIES AND RULES AND POLICY COMMITTEE
1. Approval of the minutes of the Human Services, Regulated Industries, and
Rules & Policy Committee for: August 14, 1991; August 28, 1991; and
September 11, 1991.
COMMITTEE APPROVED, 3-0
2. Resolutions referred from the Board of Health (Referred 10-1-91) :
A. Resolution 91-1842 - approving Refugee Health Grant for F.Y. 1992 -
F.Y. 1993.
COMMITTEE RECOMMENDED APPROVAL, 3-0
B. Resolution 91-1843 - approving 1992-1995 St. Paul-Ramsey County
Community Health Services Plan,a nd the 1992-1993 Indian Health Grant
for St. Paul and Suburban Ramsey County.
COMMITTEE RECOMMENDED APPROVAL AS AMENDED, 3-0
C. Resolution 91-1844 - approving 1992-1993 Maternal Child Health Plan
for St. Paul .
COMMITTEE RECOMMENDED APPROVAL, 3-0
_ D. Resolution 91-1845 - approving F.Y. 1992 - F.Y. 1993 Application for
Administration of Local W.I.C. (Women, Infants and Children) Project.
COMMITTEE RECOMMENDED APPROVAL, 3-0
3. Ordinance - amending Chapter 318 of the Legislative Code relating to
Mechanical Amusement Devices (Last in Committee 9-25-91) .
THIS ISSUE WAS LAID OVER TO THE OCTOBER 23, 1991, HUMAN SERVICES, REGULATED
INDUSTRIES, AND RULES AND POLICY COMMITTEE MEETING
CITY HALL ' SEVENTH FLOOR SAINT PAUL, MINNESOTA 55102 612/298-5378
5�46
Printed on Recycled Paper
n r,//�
�'��� ��c/3
Amendments recommended by the Human Services Committee on 10/9/91
to the Ramsey County - Saint Paul Community Health Services Plan;
related to Resolution 91-1843.
The following statements were recommended to be inserted on the pages indicated below:
,
page 2 (Addition to the listed system problems);
o Inadequate appropriation of state ftinding to finance state-mandated programs.
page 36 (Addition to recognize the current efforts regarding domestic violence);
Method lk: Identify how the SPDPH can be involved in the current coordinated,
cooperative effort with police, city attorney, citizen participation
groups and other community groups to reduce domestic violence
through education, prevention, treatment and prosecution.
Evaluation ik: Evaluation will be completed after determination of Public Health's
role in this project.
page 88 (Modification and additions to reflect the need for increased houselaold hazardous waste
sites and distribution of educational materials);
Method 4h: Printed educational materials regarding environmental issues,including
proper identi�ication and management of common household hazards
such as lead, ar-e will be available to the public upon request, through
mailings or though presentations. Various materials are developed in
non-English languages.
Method 4j: Investigate with other appropriate agencies the possibility of
increasing the number of household hazardous waste sites, with an
additional site located within the City of St. Paul.
Evaluation 4j: A cost and feasibility study will be completed to determine the
possibility of adding a household hazardous waste site.
page 202 (Addition to indicate that tlie budget and associated sta�ng for 1992 hus not yet been
approved);
NOTE: Staffing is not yet approved by the City Council.
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Community Health Services Plan
1992-1995
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Ramsey County - Saint Paul Community Health Services Plan 1992-1995
As Community Health Boards, the St. Paul Board of Health and the Ramsey County Board
of Commissioners is required to submit a Community Health Services Plan every four years,
with updates every two years,to the Minnesota Department of Health before receiving State
funding for community health services. The 1992-95 Ramsey County-St. Paul Community
Health Services Plan is a joint effort and the product of an eighteen month planning process
undertaken by the St.Paul-Ramsey County Community Health Services Advisory Committee
and the staffs of the Ramsey County Public Health Department and the St. Paul Division
of Public Health.
The State distributes funds for community health services to Ramsey County, which in turn
allocates money to the St. Paul Division of Public Health based on a population formula.
This is the only case where the City of St. Paul, Division of Public Health does not receive
State funds directly from the State. The Saint Paul Division of Public Health CHS Subsidy
Request is $949,865 for each year of the four year period.
The Plan is based on an e�ctensive Community Assessment and Prioritization Process
undertaken by staff and the Advisory Committee during 1990 and 1991. The following
elements were included in the Community Assessment:
• Social System (health, human services, political, economic, educational, religious etc)
• Place (boundaries, housing, transportation systems, availability of health resources etc)
• People (demographic impacts on public health system)
• Assessment of Health Status (age, se1c,race, income, education,residence,family size etc)
� Evaluation of C�rrent Programs (goals, objectives, community utilization/acceptance)
The Community Assessment included data collection and input from the community through
Committee-sponsored forums, District Councils, The County Citizen Survey and public
meetings. The prioritization method was adapted from CDC guideli.nes. This process
resulted in the development of almost 200 public health problem statements. From the
initial list of problems, 50 problems listed within the Plan have been identified as high
priority. Thirteen of these problems are considered to be lughest priority. Each problem
has been categorized under one of the following ten categories: - -
� Injury/Violence • Maternal-Child Health
• Environmental Health/Solid Waste • Mental Health/Chem. Dep.
• Communicable Disease • Income/Access to Care
• Elderly • Lifestyle/Cancer
• Nutrition • Dental
For each category the Pla.n addresses the public health problems identified in that category,
and the related goals, data, objectives, methods and evaluation measures. An inventory of
community-based providers of programs and services for each problem category is also
included.
A listing of the fifty Priority Public Health Problems is contained within the Plan on pages
11-14.
199Z -1993 Indian Health Grant for St. Paul and Suburban Ramsey County
The St. Paul Division of Public Health is submitting a grant to the Minnesota Department
of Health for Indian Health Services in 1992 and 1993 for St. Paul and suburban Ramsey
County American Indians. This grant is included as part of the 1992-1995 Ramsey County-
St. Paul Community Health Services Plan. If the grant is awarded, the State funding for
Indian Health services is received and managed d'uectly by the City of St. Paul, and
disbursed to the subgrantee/operating agency per a contract agreement.
The recent closing of a clinic in St. Paul which focused on serving American Indians left
many individuals without a regular, culturally sensitive source of health care. A new health
clinic is currently being established in St. Paul by the American Indian Health Care
Associarion to provide a variety of health services to this population. This proposal
addresses various components which are felt to be critical to rebuilding and improving
health resources and the health status of Ramsey County American Indians.
Representatives from various American Indian organizations and agencies in Ramsey
County were invited to a focus session to discuss the health needs of the Indian population.
As a result of tlus session and data a.nalysis the followi.ng project goals were established:
1. To reduce the rate of high risk births among Ramsey County American Indian
women.
2. To reduce the rates of chronic diseases commonly found in American Indians.
3. To improve the dental health of Ramsey County's American Indian children
and adults.
4. To reduce the rates of breast and cervical cancer, and uni.ntended pregnancies
in American Indian women.
5. To acl�owledge and assist in addressing the mental health needs of the
Ramsey County American Indian population.
_ _. _
Objectives,methods and evaluation indicators speci�c to each goal have been developed and
are described in detail in the grant proposal. Based on the belief of the focus group that
the lack of adequate transportation is one of the biggest barriers faced by American India.ns
to access and receipt of health care, and that traditional healing practices need to be
acknowledged, transportation services and referrals to Elders and Medicine Men for
traditional heali.ng measures are included as methods for each of the goals.
Additional methods include various levels of outreach, education, screening and direct
service.
The total project funds requested for the biennium is $242,636; $119,647 in 1992 and
$122,989 in 1993. The budget includes salary and fringe, travel/transportation, contracted
services and laboratory, pharmaceutical, education and office supplies and materials.
1992-1993 Maternal and Child Health Special Projects Grant
As a Community Health Board,the St. Paul Board of Health is eligible to receive Matemal
and Child Health Special Project Funds from the Minnesota Department of Health. The
amount of funds available to the City for each biennium is legislatively mandated and totals
$1,645,862. 4f the $822,931 available each year, it is legislatively directed that Health Start,
Inc. continue to receive $728,431 as funding for their programs which were supported
through Pre-Block grant funds. Health Start funding is used to support improved pregnancy
outcomes through prenatal care, and for the adolescent health programs offered in five
school-based clinics.
According to State law, MCH Special Project funds may be used to address any or all of the
following statewide program priorities: improved pregnancy outcomes, family planning,
handicapped or chronically ill children and childhood injury control. Based on an
assessment of community needs conducted for the 1992-1995 Ramsey County - St. Paul
Community Health Services Plan, the SPDPH has chosen to focus on improving pregnancy
outcomes. The Division will retain 3% of the grant amount ($24,688 per year) for
administrative costs. The remaining $69,812 will be allocated each year to subcontracting
agencies to undertake various programs targeted to improve pregnancy outcomes.
1'he overall goal of the projects which will be supported through the MCHSP Grant is:
To improve pregnancy outcomes of high risl� low income women residing in St. Pau�
The following objectives have been established for the projects during the 92-93 biennium:
• To make progress toward the goal of reducing the overall rate of late (3rd
trimester or none) prenatal care from 7.5% in 1988 (MN rate is 4.1%) to 4.5% in
1995 with a special emphasis on pregnant white teens and all pregnant African
American, Native American and Asian women.
• To make progress toward the goal of reducing the overall St. Paul infant mortality
rate from 10.3/1000 in 1988 to 9.5 by 1995 with a special emphasis on African
American women.
• To make progress toward the goal of reducing the rate of St. Paul low birthweight
infants from 6.4% (1988) to 4.0% by 1995 with a special emphasis on African
American, Native American and Asian women.
• To conduct outreach efforts to pregnant teenagers to increase the rate of first
trimester prenatal care from 31.5% (1986) to 50% in St. Paul pregnant teens by 1993
with a special emphasis on outreach to minority teens.
Six proposals from community agencies were received in response to a Request for
Proposals. Upon review and discussion of the proposals by the Proposal Review Committee,
the following 4 agencies were recommended for partial funding: Model Cities Health
Center,Inc., Face to Face Health and Counseling Services,Inc.,North End Medical Center,
and Ramsey Foundation(on behalf of St.Paul Ramsey Medical Center and Ramsey Clinic.)
Additional information on each of these projects follows.
SUBCONTRACTING AGENCIES FOR IMPROVING PREGNANCY OUTCOMES
Agency: North End Medical Center
Amount awazded: $17,000 Yl: $7,500 Y2: $9,500 �
� Target populauon: mi.nority women and women under age 30
Rice St., Mt. Airy, Thomas-Dale
Proposal: Program to support an outreach component to identi�y women
postponing or neglecting early prenatal care and worldng with
them to remove barriers and access care earlier; primarily
through written materials, information sessions, cultural
sensitivity training, group health education, and working
individually with pregnant women to access and coordina.te
prenatal care.
*Funding awarded primarily for a health educator and patient
representative to conduct outreach the lst year,and for a health
educator and a bilingual worker the 2nd year.
Agency: R.amsey Foundation (Certified Nurse Midwives)
Amount awarded: $19,000 Y1: $9,500 Y2: $9,5�
Target population: Southeast Asian families
Proposal: Maintain and expand existing program to reduce late prenatal
care in SE Asian women; primarily through home and clinic
visits by a culturally appropriate staff, referrals, in-service
education.
*Funding awarded for a bilingual (Hmong) worker.
Agency: Face to Face
Amount awarded: $53,624 Y1: $27,812 Y2: $25,812
Target population: adolescents
Dayton's Bluff, Downtown, Riverview
_ Proposal: Continue outreach/case management program; _ _
provide outreach, pregnancy testing, transportation, child care,
education and counseling, prenatal care, risk assessment
*Funding awarded to continue program.
Agency: Model Cities
Amount awarded: $50,000 Yl: $25,000 Y2: $25,000
Target population: African American and Hmong teens and women
Summit-Dale, Thomas-Da1e
Proposal: Provide social support and clinical services to
pregnant women;primarily through case management,individual
&group support,parenting education, outreach,transportation,
prenatal care, emergency assistance.
*Funding awarded primarily for outreach and transportation.
,
Special Supplemental Food Program for Women, Infants & Cluldren (WIC)
The St. Paul Division of Public Health has submitted an application to the Minnesota
Department of Health for the continued administration of a local WIC project for fiscal
years 1992 and 1993. A speci�c project budget is not submitted as part of the application
as the amount of funds distributed is determi.ned quarterly by the State and is based on the
estimated number of WIC participants in the project area. An estimated yearly e�cpenditure
plan is submitted early each calendar year.
Funds that are awarded by the State for this project are received directly by the St. Paul
Division of Public Health and are used to provide services for eligible residents of St. Paul
and suburban Ramsey County.
C�rrently almost 13,000 women, infants and children are served monthly by the SPDPH
WIC Program. Beginning October 1, 1991 our WIC Program will be authorized to serve
almost 14,000 individuals per month.
WIC provides specified supplemental foods (milk, eggs, cheese, vitamin C-rich juices, dried
beans and peas, iron-rich cereals and iron-rich infant formula), individualized nutrition
education; and referrals to many health and social services such as jobs training programs,
Children's Health Plan, Early Childhood Family Education, low-cost dental services etc.
The following activities will be performed as part of the WIC progra.m:
• assess nutritional risk and assign priority
• prescribe food package and change package if necessary
• prepare nutritional education plans and approve nutritional education materials
� provide one-to-one nutrition education
• develop individual care plans for participants at high risk
These activities will be performed by nutritionists, home economists, registered dietitians,
dietetic technicians and other individuals currently approved as a competent professional
authority.
- Eight cluucs (lO locations) serve as certification and voucher pickup sites for the SPDPH
WIC Program. Services are provided at these locations for a total of 92 days per month.
The proposed service area has Hmong, Spanish and Cambodian speaking populations.
Seven Hmong/English bilinguals are on staff at SPDPH. The services of a Cambodian
interpreter are available and several staff members are fluent in Spanish. Translation
resources are also available for hearing impaired participants.
Prenatal and postpartum evaluation and prenatal visits are provided through a written
�agreement between the St. Paul Division of Public Health WIC Program and several
community clinics. Family planning services are also provided directly by SPDPH. Infant
and child health supervision visits and preventive health education, school readiness and
learning disabilities identification are provided directly by the SPDPH for refugee infants
and children, and through written agreements for non-refugees. The exception is for
immunizations,which are provided both d'uectly and through written agreement for all WIC
clients.
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Refligee Health Grant
The St. Paul Division of Public Health has submitted a Refugee Health Grant to the
Minnesota Department of Health for the period October 1, 1991 -September 30, 1993. The
total budget requested for the biennium is $49,270. If awarded the grant, the funds will
come directly to the St. Paul Division of Public Health.
The goal of the project is:
To provide health screening to newly arrived refugees in 1Zamsey Counry and to facilitate transfer
into ongoing sources of health care in tlze community.
The project addresses five broad areas for which the following objectives have been
developed:
1. Outreach
To notify newly arrived refugees of the need for a health assessment.
2. Health Care Services
To provide to newly arrived refugees, a comprehensive medical examination
for clinically apparent problems,such as malnutrition or anemia,screening for
infectious diseases and a determination of their general health status.
3. Tuberculosis
To assure that refugees in need of preventive therapy for tuberculosis are
placed on such therapy and monitored for compliance.
4. He�atitis B
To assure that all refugees are screened for Hepatitis B Vaccine carrier status
and that newborns and susceptible household contacts are vaccinated.
_ _ _ 5. 1Vlonitoring & Follow Un _ �
Monitoring and follow-up will be provided to ascertain that screening is
completed and that conditions necessitating continuing care are followed. �
Methods include outreach, screening, direct service, referral and evaluation and are
described in detail in the grant proposal.
The funds requested are for the salary and fiinge of a Health& Education Assistant for the
two year project period.
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, 1992-95 RAMSBY COUNTY-ST. PAUL COI�IIiUNITY �ALTH SBRVICBS PLAN
Table of Contents
� Summary
Dedication Page. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
� Preamble. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Community Assessment Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Priority Problem List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
� Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Goals, Objectives, Methods, � Svaluation
� In'ur /Violence:
Problems Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Key Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
� Objectives/Methods/Evaluation:
-Ramsey County Public Health Department. . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
-St. Paul Division of Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
� Inventory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Maternal-Child Health:
Problems Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
, Key Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Objectives/Methods/Evaluation:
-Ramsey County Public Health Department. . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
� -Joint Ramsey County/St. Pau1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
-St. Paul Division of Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62
Inventory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
� Environmental Health/Solid Waste:
Problems Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72
Key Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
� Objectives/Methods/Evaluation:8
-Ramsey County Public Health Department. . . . . . . . . . . . . . . . . . . . . . . . . . . . .78
-St. Paul Division of Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
� Inventory (Recycling & Yard Waste Programs) . . . . . . . . . . . . . . . . . . . . . . . . .89
Inventory (Environmental Health Providers/Advocacy) . . . . . . . . . . . . . . . . .92
Mental Health/Chemical De endenc :
� Problems Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93
Key Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95
Objectives/Methods/Evaluation:
� -Ramsey County Public Health Department. . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
-Joint Ramsey County/St. Pau1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
-St. Paul Division of Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
� Inventory (Mental Health) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Inventory (Chemical Dependency) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
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� 1992-95 RAMSBY COUNTY-ST. PAUL COMMUNITY HBALTH SERVICSS PLAN
Table of Contents (cont. )
, Communicable Disease:
Problems Goa1s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Key Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
, Objectives/Methods/Evaluation:
-Ramsey County Public Health Department. . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
-Joint Ramsey County/St. Pau1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
� -St. Paul Division of Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Inventory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Income/Access to Care:
� Problems Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Key Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Objectives/Methods/Evaluation:
, -Ramsey County Public Health Department. . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
-Joint Ramsey County/St. Pau1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
-St. Paul Division of Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
� Inventory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Elderly:
Problems/Goa1s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
� Key Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Objectives/Methods/Evaluation:
-Ramsey County Public Health Department. . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
� -St. Paul Division of Public` Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Inventory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Lifest le/Cancer:
� Problems Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Key Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Objectives/Methods/Evaluation:
� -Ramsey County Public Health Department. . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
-St. Paul Division of Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Inventory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
� Nutrition:
Problems Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
� Key Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Objectives/Methods/Evaluation:
-Joint Ramsey County/St. Pau1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Inventory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
iDental:
Problems/Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
� Key Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Objectives/Methods/Evaluation:
-Joint Ramsey County/St. Paul. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
-St. Paul Division of Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
� Inventory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
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1 1992-95 RAMSBY COUNTY-ST. PAtJL COI�IIKUNITY HEALTH SBRVICES PLAN
Table of Contents (cont. )
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Minnesota Department of Health Forms:
1 Ramsey County CHS Cover Form, Assurance & Agreements. . . . . . . . . . . . . . .179
St. Paul CHS Cover Form, Assurance & Agreements. . . . . . . . . . . . . . . . . . . . 182
Ramsey County Immunization Program Agreement. . . . . . . . . . . . . . . . . . . . . . . 185
St. Paul Immunization Program Agreement. . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
� Ramsey County Record of Administrative Requirements. . . . . . . . . . . . . . . .189
St. Paul Record of Administrative Requirements. . . . . . . . . . . . . . . . . . . . .191
Ramsey County Budgets: 1992-95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193
1 St. Paul Budgets: 1992-95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197
Ramsey County CHS Staffing by Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
St. Paul CHS Staffing by Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202
1 Ramsey County Contract List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .203
St. Paul Contract List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .204
Index of Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .212
CHSPlan Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215
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Indian Health Grant for St. Paul and Suburban Ramse� Countv American
' Indians (Submitted bv the St. Paul Division of Public Health) :
Title Page. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .223
Table of Contents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .224
' Face Sheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225
Project Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226
Evidence of Compliance - Worker's Compensation. . . . . . . . . . . . . . . . . . . . .227
Application Narrative
' Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229
Problem Statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229
Goals, Objectives, Methods and Evaluation:
' High Risk Births. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .232
Chron. _ _ _- _ _ _
ic Disease Rates. . . . . . . . .�. . . . . . . . :-. . . . . . . . . : : . . . . . . . . . . . . . . . . .235_...
Dental Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237
Breast/Cervical Cancer, and Unintended Preqnancies. . . . . . . . . . . . . . . . .239
� Mental Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .242
Budget Justification:
1992. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .245
' 1993. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .247
Appendix
Data on American Indians. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .249
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� 1992-95 RAMSEY COUNTY-ST. PAUL COMMUNITY HEALTH SBRVICES PLAN
The 1992-95 Ramsey County-St. Paul Community Health Services Plan is
� the product of an eighteen month planning process undertaken by the
St. Paul-Ramsey County Community Health Services Advisory Committee,
the Boards of Health of Ramsey County and the City of St. Paul, and
� the staffs of the Ramsey County Public Health Department and the St.
Paul Division of Public Health.
� 1990-1991 St. Paul-Ramsey County
Community Health Services Advisory Committee
� David J. Cheesebrow, RN, Chair
Linda M. Webster, Vice Chair
Wanda Miller, RN, Chair, Personal and Community Health Subcommittee
, Kent Rees, Chair, Environmental Subcommittee
Margaret Anderson, RN Howard E. Bergstrom
� Jean Brown, RN Beckie Conway
Janice Ray Hallman Harry Krulewitch, M.D.
Peg LaBore Bruce Larson �
Touxa Lyfoung Jean F. Malacko, Consumer
, Denny Ray McClelland Gary Miles
Tamsen W. Morgan, PA Diane 0'Brien
Jo Anne Rohricht, Consumer Ken Rothman
� Esther Tatley, RN
� RAMSBY COUNTY CITY OF ST. PAUL
James Scheibel, Mayor
� Ramsey County Board of Health St. Paul Board of Health
Hal Norgard, Chair William Wilson, Council President
� Diane Ahrens Tom Dimond
John T. Finley Roger J. Goswitz
Ruby Hunt Bob Long
� Duane McCarty Paula Maccabee
Donald E. Salverda Janice Rettman
Warren W. Schaber David Thune
� Terry Schutten, County Executive
Director
� Ramsey County St. Paul
Public Health Department Division of Public Health
Rob Fulton, Director Katherine Cairns, Director
� Donald Gault, Diane Holmgren,
Assistant to the Director Health Administration Manager
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gu�Y-y Preamble
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The St. Paul-Ramsey County Community Health Services Advisory
, Committee and staff from the St. Paul Division of Public Aealth and
the Ramsey County Public Health Department completed a broad-based
Community Assessment and developed a list of fifty Priority Public
Health Problems in 1990 and 1991.
� In doing so, the Advisory Committee identified a number of primary
issues which underlie and are frequently the root causes for the
� discrete Public Health Problems identified in the Community
Assessment. These issues are:
� o Poverty;
o Homelessness;
� o Racism;
o Low self-esteem;
� o The growing nwnbers of frail elderly and disadvantaged
minorities; and
� o Increasing environmental risks.
The problems contained in the following pages are impacted, and often
� caused by, one or more of these primary issues. The Advisory
Committee and staff also identified system problems which underlie and
compound the problems. These system problems are:
� o Lack of public policy to address/assure access to
affordable health care;
� o Institutional inefficiencies and bureaucratic
roadblocks in the public and private health care and
social service systems;
� o Lack of affordable transportation for individuals/
groups to access health services at present locations;
� o Lack of convenient access to preventive health services in
some areas of Ramsey County;
1 o Lack of performance and management standards and meaning-
ful evaluation systems among Public Health providers;
� o Lack of community planning for long-term care needs;
o Inadequate reimbursement for preventive health services
provided by community agencies;
� o Lack of adequate education;
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Summary Preamble
o A 1991 U.S. Supreme Court decision banning discussion of
�
abortion in family planning clinics receiving federal ,
funds, which may limit the ability of the community to
meet the Maternal and Child Health Goals contained in this
Plan, and could lead to an increase in the number of
children living in high risk settings; �
o Limited nwabers of bi-cultural, bilingual health care
professionals and paraprofessionals, especially in �
nursing, leading to low levels of access and understanding
of needed health care services by disadvantaged
minorities; and
o Lack of support systems to assure adequate health care and �
communication at times of natural or human-made disasters.
The 1992-95 Ramsey County - St. Paul CHS Plan begins with a detailed i
description of the Community Assessment undertaken by staff and the
Advisory Committee during 1990 and 1991, and the list of Priority �
Public Health Problems identified as a result of the process. A
demographics section follows, describing the total population and
ethnic and racial groupings within Ramsey County. The Demographics
section is followed by the fifty identified problems broken into ten �
categories: Injury/Violence; Maternal-Child Health; Environmental
Health/Solid Waste; Mental Health/Chemical Dependency; Communicable
Disease; Income/Access to Care; Elderly; Lifestyle/Cancer; Nutrition; �
and Dental.
The section of the Plan addressing each category is organized as
follows: �
1. A listing of the Problems identified in that category, and the
Goals that are sought related to each Problem. �
2. Key data that compare the problems in Ra.msey County, the State,
and in some cases the U.S. ,
3. A set of Objectives, referencing the specific Problem(s) , followed
by a series of Methods and Evaluation measures. This section
separates Objectives, Methods, and Evaluations undertaken by the �
Ramsey County Public Health Department, those jointly operated by
the two agencies, and those undertaken by the St. Paul Division of
Public Health. �
4. An Inventory listing community-based providers of programs and
services for each problem category. �
In order to address the scope of the problems contained in this Plan,
a series of community-based, system-wide efforts will be necessary
during 1992-95. The Objectives and Methods in the Plan are desiqned to �
foster and assist in these efforts across the Ramsey County community.
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Summary Community Assessment
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In January, 1990, staff from the Ramsey County Public Health
� Department and the St. Paul Division of Public Health began working
with the St. Paul-Ramsey County Community Health Services Advisory
Committee on the 1992-95 CHS Plan. At that time, the following
schedule was proposed and approved; with the exception of delaying the
� final CHS Public Meeting to Auqust, 1991, this schedule was largely
adhered to throughout the Planning Process:
� 1992-95 Ramsey County-St. Paul CHS Planning Process Calendar
� o February, 1990: Develop proposal for review at March
Subcommittee meeting; form internal Department/Division
Committees to begin work on Proqram Evaluation formats.
� o March, 1990: Reach consensus with Advisory Committee on
formats/data to be collected for Community Assessment, Program
� Evaluations.
o April, 1990: Begin data collection for Community Assessment,
Program Evaluations.
� o May-October, 1990: Update Subcommittee/Committee on data
collection process for both Community Assessment and Program
� Evaluations; hold Committee-sponsored forums on selected
topics/issues.
� o November-December, 1990: Advisory Committee and staff identify
subgroups/target populations, significant community public
health problems.
� o Januaiy-March, 1991: Staff draft Goals, Objectives, and
Methods.
� o April, 1991: Advisory Committee review of final draft of CHS
Plan
o May-June, 1991: CHS Plan Public Meetings
■ o July, 1991: Final modifications based on Public Meetings
� o August-September, 1991: Approval by County Board and City
Council
� o October, 1991: Submission of CAS Plan to MDH
At its March and April, 1990 meetings, the CHS Advisory Committee
, approved both the following elements to be included in the Community
Assessment, and the process for completing the CHS Plan:
� 4
,
�
Summary Community Assessment
1992-95 RAMS$Y COUNTY/ST. PAUL CHS CO1rII�IUNITY ASSBSSMBNT �
o Social System �
Health
Human Services, Welfare
Family
Political �
Economic (incl. tax base)
Recreation
Educational �
Communication
Religious
Corrections, Crime
Legal �
Cultural Values/Volunteerism/Peer Support/CD Programs, Norms
Sense, Significance of Neighborhoods
Isolation �
o Place
Boundaries (real, perceived) �
Climate
Flora & Fauna, Green Space
Human-Made Environment (Environmentalist, Public Health)
School Districts & Subdistricts �
Geographic Features
Housing (Neighborhoods, quality, supply, availability,
access, barrier-free buildings) �
Transportation system(s) , mobility
Availability of Health Resources (Location of services,
access, demographics, financing, providers/resources,
insurance/financing) �
o People (Demoqraphic i.mpacts on Public eealth System)
Age �Occupations
Sex
Religion �
Birth & Death Rates (Minority rates)
Residence
Morbidity/Mortality - Causes (Genetic abnormalities)
Education (Literacy) �
Geographic Distribution
Income
Population Density �
Family Size
Population Growth/Decline Trends
Race/Ethnicity/Cultural Norms (Alcohol/drugs, health �
customs, sexual practices/orientation, cultural differences,
languages, refugee, documented status)
Workers vs. residents
Insured/uninsured/underinsured �
5 �
�
�
Summarv Community Assessment
�
o Assessment of Health Status
� Age Income & Education
Sex/Gender Family Size
Race/Ethnicity Occupational Level of
� Residence/Location Head of Household
� »»>IDBNTIFY SUHGROUPS/TARGBT POPULATIONS
»»»IDBNTIFY SIGNIFICANT PROBLBMS
�
o Evaluate Current Programs
� Mandate?
Goals/Objectives Achieved? Secondary Gains?
� Community Utilization/Acceptance?
What Problem Does Program/Service Address?
o Effective, efficient, appropriate?
o Impact on problem?
� o Effect of reduction/elimination of program?
� Community
Assess�nt
� Data*
Public Health Scope/Principles/Objectives
�
Community/Department � Division Priorities/Policies/Objectives
�
Bvaluation of
Current Proqrams
�
Priority Problems
�
Write Goals, Objectives � Methods to A�ddress Priority Problems
� * In 1 mmunit in ut hrou h Advis mmi ommi t e-
c udes co y p t g ory Co ttee, C t e
sponsored forums, District Councils, School Districts, County
, Citizen Survey, etc.
, 6
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�
Summarv Community Assessment
�
In November and December, 1990, staff distributed two primary packets
of health data for staff and Advisory Committee review and analysis in �
order to identify Priority Public Health problems in Ramsey County.
The information contained in these packets included:
o Ramsey County Citizen Survey - Public Health results; �
o Child and Age Dependency Ratios for the seven-County metro �
area;
o Minnesota data on Years of Potential Life Lost;
o Data on causes of death in Ramsey County as a whole as well as �
the City of St. Paul;
o National data on cancer deaths; �
o Data on the incidence of AIDS statewide and locally, as well as �
summary pages from a recent Minnesota AIDS Funding Consortium
report;
o Excerpts of data on Senior health needs from the Wilder �
Foundation's Older Minnesotans report;
o The Wilder Foundation's Minority Elders in Minnesota report; �
o Excerpts from the Ramsey County Adolescent Parents report;
o A summary and data listing of maternal-child health indicators �
in the seven-County metro area;
o A report on live births and induced abortions in Ramsey County, �
St. Paul and suburban Ramsey County;
o A report on cocaine babies in Ramsey County; ' �
o A summary of MCH problems and needs developed by the Personal
and Community Health Subcommittee of the CHS Advisory Committee
in the summer of 1989; �
o Miscellaneous MDH data compiled to compare Minnesota, Ramsey
County, St. Paul, and suburban Ramsey County;
I �.
o Children s Defense Fund data on the Children of Ramsey County;
o Summary information from a federal report on the cost- �
effectiveness of MCH programs;
o Excerpts from the St. Paul Housing Authority/ Wilder study of �
residents of public housing in St. Paul;
7 �
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Summarsr Community Assessment
�
� o Minneapolis/St. Paul Metropolitan Area Druq Abuse Trends,
December 1990, published by the Minnesota Department of Human
Services;
� o Communitv Health Needs Assessment, November 1990, published by
Carondolet LifeCare; and
� o WRC REPORT: Important Social Trends, Fall 1990, published by
the Wilder Research Center.
� In order to synthesize this broad range of information into a listing
of Priority Public Health Problems, in November and December of 1990,
staff and the Advisory Committee developed a prioritizing method,
� adapted from the Hanlon Method/Basic Priority Ratinq �stem (A Guide
for Establishing Public Health Priorities, CDC, 1989) as well as
recommendations from the Minnesota Department of Health. The method
� is summarized on the following page.
In addition, in January of 1991, staff and the Advisory Committee
developed a simple Program Description format which was used to
� inventory all current programs and services provided and/or funded by
the Ramsey County Public Health Department and the St. Paul Division
of Public Health. This format is summarized below:
� ---------------------------------------------------------------------
1992-95 RAMSBY COUNTY/ST.PAUL COI�MUNITY H�SALTH SBRVICBS PLAN
CURRENT PROGRAI�I DBSCRIPTIONS: JANUARY, ' 991
� SPDPH RCPHD
' Program Title:
� Services Provided:
� Problem(s) Program Addresses:
Service Data (Number of Persons Served, Units of Service Provided
� Annually) :
Target Population(s) :
� Staffing, Budgets (Revenues and Expenditures) :
Mandated Service? Yes No
� ---------------------------------------------------------------------
� $
�
�
Swomarv Coaanunity Assessment
�
RAl�ISBY COUNTY/ST. PAUL CHS ADVISORY COI�IITTEB
RECOMMBNDBD CRITBRIA AND WSIGHTING FOR DBTSRMINING PRIdRITY PROBLEIrIS �
Phase One Prioritization: Size and Seriousness of Problem
CRITERIA WSIGHT SCORE*
1. Estimate of persons potentially 2.0 �
affected by the problem (persons at risk)
2. Estimate of persons at-risk actually 2.5 �
affected by problem
3. Premature death (years of potential life 1.5 �
lost)
4 . Severity (extent to which the problem 2.0 �
limits one's ability to live their life
the way they want to)
5. Actual or potential economic burden to 2.0 �
the community
6. Public Concern (perceived threat) 1.0 �
TOTAL:
Phase Two Prioritization: Bsti.mated Bffectiveness of Intervention,(s) �
1. Propriety (extent to which it is appropriate/
possible for agency(ies) to address problem 1.0
2. Economic Feasibility 1.5 ,
3. Acceptability (will community and/or target 1.0 ,
population(s) accept implementation of
proposed intervention(s)?)
4. Resource Availability 1.5 �
5. Legality 2.0
6. Preventability �
a. Availability/feasibility of primary
prevention level of intervention 2.5 �
b. Availability/feasibility of secondary
prevention level of intervention 1.75
c. Availability/feasibility of tertiary �
prevention level of intervention 1.0
TOTAL:
* eigh: Multiply Weight X2; Medium: Multiply Weiqht X1; Low = 0 �
9 �
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�
Summarv Community Assessment
r
Using this prioritizing method, staff and the Advisory Committee
� identified a draft list of Priority Public Health Problems in January
and February of 1991. On February 19, 1991, the Health, Human
Services and Corrections Committee of the Ramsey County Board of
Commissioners reviewed the draft Priority Problem List and recommended
� several modifications. On March 6, 1991, a Public Meeting was held in
the Penthouse of the Science Museum of Minnesota to gather public
input on the draft Problem List. Following this input, the Advisory
� Committee adopted the final list of fifty Priority Public Health
Problems contained on the following four pages. On August 7, 1991, a
Public Meeting was held to gather input into the final draft CHS Plan.
Persons speaking and providing written comments at the March 6 and
� August 7 Public Meetings included:
List of Speakers Commenting on__Priority Problem List
� at the March 6, 1991 Public Meeting
Name Organization
� Tim Hammond Lutheran Social Services
Donna Zimmerman Health Start
� Nancy Briggs North End Medical Center
� Malcolm Mitchell Block Nurse Program, Inc.
Ann Ricketts Face to Face Health & Counseling Ctr
� Nancy Smith Caregiver's Support Project - DHS
List of Speakers Commentinq on the Final Draft CHS Plan
, at the August 7, 1991 Public Meeting
Name Organization
� Marcheta Madden United Family Practice/Helping Hand
Carol White Aealth Care for the Homeless Project
� Malcolm Mitchell Block Nurse Program, Inc.
� Nancy Briggs North End Medical Clinic
Dick Dolan District 2 Community Council
� Paul Gilliland District 2 Community Council
Mary Jo Leer Merriam Park Community Council
, Tom Yardic West Side Community Health Center
� 10
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g�$ry Priority Problem List
� 1992-95 RAMSBY COUNTY-ST. PAUL COI�IIrIUNITY HBALTH SBRVICBS PLAN
What follows is a listing of the fifty major Public Health Problems in
, Ramsey County which have been identified through the Community
Assessment and Prioritization processes. The listing begins with
thirteen problems which have been identified as highest priority by
� the St. Paul-Ramsey County Community Aealth Services Advisory
Committee. These are followed by the thirty-seven additional high
priority problems that were identified by the Advisory Committee and
� the staffs of the Ramsey County Public Health Department and the St.
Paul Division of Public Health.
� Thirteen Biqhest Prioritv Public Health Problems in Ramsey County
o Lack of access to health care, particularly among working poor,
� and children living in poverty
o Increasing number of reports of child abuse, domestic abuse, and
� abuse of the elderly and disabled
o High occurrence of abuse and neglect of children being born to
large numbers of sinqle women and/or adolescents, as well as
� parents who are actively abusing/addicted to chemicals
o High number of children at risk for injury and illness due to
, various day-care and school safety and hyqiene issues, i.e. food
safety, communicable disease, lead, and structural/equipment
concerns
� o Occurrence of late or no entry into prenatal care, particularly in
communities of color
� o High rate of unintended pregnancy among teens
o Increasing prevalence of all sexually transmitted diseases
� o Prevalence of vaccine-preventable diseases, including measles and
hepatitis
� o Prevalence of groundwater, surface water, soil, and air pollution
o Increasing numbers of inentally ill individuals living in the
� community who need assistance in medication management and daily
living tasks
, o High rate of inability for self-care among persons 85+, the
fastest growing age cohort in the population; inability/difficulty
of elderly to perform Activities of Daily Living (ADLs)
,
� 11
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Summary Prioritv Problem List
�
o High rate of need for caregiver support for homebound elderly
o Increasing prevalence of chronic diseases due to lifestyle choices �
Additional High Priority Public Health Problems in Ramsev Countv �
o High number of deaths, disabilities, and Years of Potential
Productive Life Lost associated with motor vehicle accidents �
o High occurrence of deaths and disabilities associated with
childhood/adolescent unintentional injuries
o High incidence of deaths and disabilities due to unintentional �
injuries in persons of all ages, and persons between the ages of
15-24 in particular �
o Increasing incidence of suicide and homicide deaths among people
ages 15-24
o High incidence of malignant neoplasm deaths, including increasing ,
rate of lung cancer, which is the leading cause of cancer-related
death in Minnesota, and increasing incidence rates of new cancers �
of the breast, lung, cervix and the colon/rectum
o High infant death rate among high risk groups, incidence of Sudden �
Infant Death Syndrome deaths
o Lack of parenting skills for child care/parenting
o High prevalence of high risk & premature births �
o Increasing incidence of low birthweight births among Southeast �
Asians; high incidence of low birthweight births among Blacks and
American Indians; high birth rates among Southeast Asian and Black
teenagers �
o Prevalence of chronic illness/disabilities associated with
genetic/metabolic disorders, developmental delay, injury
o Prevalence of pediatric asthma �
o Lead-based paints: ingestion by children, improper removal and �
disposal, incidence of lead poisoning cases in Ramsey County
children
o Occurrence of bacteria, viruses, pesticides, and chemicals in food ,
resulting in illness and/or toxic exposures
,
12 ,
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Summarv Priority Problem List
ro Occurrence of exposure to second-hand smoke in public facilities
due in part to lack of awareness/enforcement of the Minnesota
� Clean Indoor Air Act
o Higher than average radon concentrations in Ramsey County homes
� o Occurrence of sick building syndrome
o Workers at risk from improper disposal of household hazardous
� waste, infectious wastes, illegal drug labs, explosives/
ammunitions, etc. ; garbage haulers and Solid Waste facility
operators
� o Instances of improper disposal of household and industrial
hazardous waste
� o Increasing amount of unsafe and poor quality housing
o Prevalence of chronic illness/impairment in children and adults
, associated with Fetal Alcohol Syndrome and other drug abuse;
increasing prevalence of drug-attached newborns and cocaine babies
o Prevalence of chronic illness/disabilities associated with
� alcohol, other chemical and IV druq abuse
o Increasing prevalence of chronic illness/disabilities associated
, with smoking/tobacco use in teens
o Increasing prevalence of psychiatric and chemical dependency
problems in non-English speaking populations
� o Increasing prevalence of automobile driving under the influence of
alcohol and various chemicals
� o Mental health problems and chemical abuse/dependence among the
elderly
� o Increasing prevalence of HIV infection; disproportionate
prevalence among Black and Hispanic populations
� o Numbers of adolescent males at high risk for HIV infection
o Existence of potential for spread of communicable disease by sick
� workers, including but not limited to spread of Hepatitis B from
accidental needle sticks, to health care workers, day care
providers, first responders, solid waste handlers, etc.
, o Increasing prevalence of Hepatitis B carriers
o High prevalence of chronic disease in minority and low-income
� populations
� 13
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Summary Priority Problem List
o Prevalence of chronic illness/disabilities associated with poor ,
nutrition
o Prevalence of chronic disease associated with obesity �
o Inadequate quality of food, leadinq to prevalence of chronic
disease and malnutrition �
o Dependence of populations/individuals on food shelves/commodities
(poor quality, uneven supply) , leading to prevalence of chronic �
disease and malnutrition; high prevalence of residents of public
housing skipping meals and relying on food shelves/commodities for
food
o High prevalence of gum disease in general population �
o High prevalence of dental caries in low-income people �
o Increasing incidence of baby bottle caries
,
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gummary Plan Organization
�
The Plan begins with a graphic display of Demographics, describing the
, total population, and ethnic and racial groupings within Ramsey
County. This is followed by the fifty identified problems grouped
into ten categories:
rInjury/Violence
Maternal-Child Health
, Environmental Health/Solid Waste
Mental Health/Chemical Dependency
Communicable Disease
Income/Access to Care
� Elderly
Lifestyle/Cancer
Nutrition
� Dental
� The section of the Plan addressing each category is organized as
follows:
1. A listinq of the Problems identified in that category,
� and the Goals that are sought related to each Problem.
2. Key data that compare the problems in Ramsey County, the
� State, and in some cases the U.S.
3. A set of Objectives, referencing the specific Problem(s) ,
followed by a series of Methods and Evaluation measures. This
, section separates Objectives, Methods, and Evaluations
undertaken by the Ramsey County Public Health Department,
those jointly operated by the two agencies, and those
� undertaken by the St. Paul Division of Public Health.
4. An Inventory listing community-based providers of programs and
� services for each problem category.
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g�ry Demoqraphics
� , ,
Ramsey County is located in the center of the Twin Cities metropolitan
� area. It is both the smallest County in the State geographically,
occupying 155 square miles, and the most densely populated. According
to U.S. Census counts, there were 485,765 persons residing in Ramsey
County in 1990, compared to 460,617 in 1980. The 1990 census included
� 272,235 persons residing in the City of St. Paul and 213,530 residing
in Suburban Ramsey County. The racial and ethnic makeup of Ramsey
County are summarized in the graphic tables which follow. '
� 1. The Health Planning Areas and census tracts within Ramsey County
are illustrated in the following graphic:
�
N.�•pK. M.H.�q10.�OM ��i01
�NAt.�N.O� NI.N.�O.Ot.tlif.M101.�W.OL
� y.M.�O�.Y
I�i�/
Max�dsvi�w « 731
NaM Oaks
� mw..,.r �j
��M.n w�
�ni►�nn. WhIY�BN/
m
727 w�
726 Aia.n Nab 7yg
� ��M� �
Shorsvisw
Vadnais Hsiyhb
� E�H.�t.
€.n.a
aaa.��as•r..r.���..aam.�a � �sa1.�aa�nw.mQ.
.wn.wa au..aa
7T4 w«..wa m
� � LIfW Canada
723 725
Roa�viW
� Ab.St Paul
� N►yM.O#
�
iiiiKil� ir.10< �YI.�Riel i�.�.i1I.01]e1.M
Fakon o+��.. +K a��.m a. �
601 � �2 604 HaYd�n HsiDhta
Como Padc Phd�n Par1�
��ndwrry Pk 603 „a.,,ras
� „R m �� »rs�.an.�
606 ': 607 � 611
1M.L 3 11f.1N.1M.fr.
� • HIm�II M91 � � 71��1.iMW H�je�
Thomu•Dar� a An�iry 610 PaAc
a..arm.aasaK y� payfonyBluN
, �iar.a,a�n,s. aLa'.aaa4s�.a�
a�.s�e.er.s 614 u�m.n�a
612 Summif-Dal� "'.°•."'.,,e
Mwlnf�r
a.aaa►as.aaa. 617
q;wrv;rw 618
� 616 ��,.,k
:a.,,....�..
w.�m s�
Hg�aP.,� RAMSEY COUNTY �,
, Health Planning Areas N y '�
and their constftuent census tracts p O '
O`�
.`.:�..~.�.4°"r..."'�.. C�
o.
, 6X7I-SL P�ul NPA
77[X-SWv6�n HPA �
Loeal M�Nanu �
pTC
01��s1�1�
� la�
16
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Summarv Demoqraphics
2. The Ramsey County population broken out by race and ethnic group, �
and a census of non-white populations living in Ramsey County are
illustrated in the following table. As demonstrated in this �
table, 12� of the total Ramsey County population is non-white: �
among St. Paul residents, 18� are non-white, while less than 5� of
the population residing in Suburban Ramsey County is non-white.
CENSUS OF RAMSEY COUNTY POPULATION BY RACE �
and ETHNIC GROUP,1990 • '
rru��s�awrsxsorrs nxcwr nuranunon �
�C�O� ta�ty SWt R���q SN�t
c..n� rm e.ww c..u� rw s.�w.
All nea, uul......�.... �t7,76S 37l�7S 2IS�70 IOO.OL I00.0� 100.0* �
wuu...................... �n.s'n �21.9�7 20Ii.770 it.0* t33� 9SA�
■I�et......."'............ 23.67� 10.0tl 3.791 t.l� 7.�s 121►
t�e�....................... �,wa s.e9'r n� asn i.�s o.�s
A�I��...................... 2�.792 19.147 SS95 S.1* 7.1�i 2HL
Ot�.r...................... 41t7 Salt �@ 13i 20R OAi �
All MYde �np,, bW- YJ.76f ITl.27S SU,S10 l00.0i IO0.0i 100A96
91����IS.................. 17.M0 1fA'� 2AIS 19* �.2* I.li
PI��.HI����la........... 171,175 264�3! 211.116 97.1� 9S.ts 9L9i
NOTt: iB�f�l�r�PreM�A�NY^�a1P�r��ahwd7�7�tiita���1r� �
�+.r.w.owor.rw...r.ta.erc��..�.. Y4M�ISOrtCr��is
x�.�r a��.a r r u.cs c�rr.'rr rr:rurw.c�...w�r m.e��,.w
...�.�r.s xyr.
�
CENSUS OF NON-WHITE POPULATIONS
LIVING IN RAMSEY COUNTY, 1991
Penoas �
30.000
u.aoo
zo.aoo �
�
��
is.oao S �
�yy� xY r'3 ��
iQ�wv :;.p, .. �
�� �u
5.000 �` ��
<� � ;.
� a`< ,�';� s a
�r% ,'°_i w, :, -i
O :z:�. .;�a .«..�:s .. �.::a �
Asl�a Black ledlas Ot6er
�St hol �Sabarss
I�L YYIh�� ,
AMY/Lr�
Additional data on the Southeast Asian refugee population. Yesiding in
Ramsey County include the following: ,
o More than 15,000 Southeast Asian Refugees live in Ramsey
�unty, accounting for over 3� of the County's total population, and ,
of the total Southeast Asian Refugee population in the State.
� this total there are an estimated 9,500 Hmong, 2,500 Cambodians,
Vietnamese, and 600 Laotians. �
17 �
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g�ry Demoqraphics
�
o The City of St. Paul has the fifth largest concentration of
� Southeast Asian Refugees in the United States. Southeast Asians
represent the largest minority population in the St. Paul Schools,
accounting for one in every six students at the beginning of the
1990-91 school year.
� o Southeast Asians account for 76$ of all residents of St. Paul
public housing. "
� wn f hildren
3. St. Paul minority populations, including a breakdo o c
and adults, and the overall racial distribution in St. Paul, are
� illustrated in the following graphics:
� SAINT PAUL MINORITY POPULATIONS,1990
Souact: 1990 I1S.Census
, Number
:....•
i
�.� .�
�..... ,..,.
� �
�M�NYrI
1�.N� S�
9'y»'.,
.
�
�
� 72.N� �
i
�.N�
I
I 7.ii1
� �.N� �.IN � .
� �
�
qut Y1�n IMIM 01Mr
� Race
, RACIAL DIS'I'RIBUTION OF SAINT PAUL POPULATION
Sousce: 19901lS.Census
, p wei�.
ioeal population.�35 �"`
:�;�i;:t,:�.
■�wk
au.«. zrs
`t'�ir.iii`'•"`"••�{`?:
, '•.�;r:::'::i:;;:�:
i.�«r::t:t:'ii r�{l
�.m ■A�Ian
i.Nt 7•/f
, :�':j}��5�+4`+{`... �Mq
��"�ir��i�•'ii�:�:t: O IMMn
•:i:iti.:i:ti::' K�u 4K
, O ae..
rrrr..w�w
, �v
,
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Summary Demoqraphics
�
4 . As demonstrated in the following graphic comparison of St. Paul
and Minneapolis minority populations, the Asian population in St. �
Paul constitutes a far greater of the minority population than
found in Minneapolis, while the Black and American Indian
populations in Minneapolis are proportionally larger than those
populations in St. Paul. �
MINORITY POPULATIONS IN NEIGHBORING CITIES: �
COMPARISON OF PERCENT DISTRIBUTION
Soaree: 1990 U.S.C�wa� �
St Paul Minneapolis
Non-Whttas.189G Non Wkutes:2276 �
� �`� �J.#O!i
.fi £e�sa' :��� ;
�� s,�.� ����. ;K
�;H� w °`� �
.2. . �.' �, • . .
. ,: . :.,.:.
u�. .
.3.�$ �..'r
7.7% �:�;"� �
J3� �`~
�
�Black 0 Asian �Indian
,
POPULATION [N 1990
s.�M w�n.. �
■.e r.� .w�a
^�n•�• Dl2t! 3E/3R1
�� �� ��
� s� �� �
PD�Y[ lmoa t0o0a •
°"` � L�AI;L
r""� 1MG 3�3ti
dr �y py� ,
w�r arr r wr wr
,
5. As demonstrated in the table on the following page, the ethnic
distribution of Southeast Asian refugees living in Minnesota ,
differs from the distribution found in Ramsey County: the Hmong
account for 36$ of Southeast Asian Refugees statewide, compared to
63� in Ramsey County; Vietnamese account for 35$ of Southeast ,
Asian Refugees statewide, compared to 13� in Ramsey County;
19 ,
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gu�=-y Demographics
, �
Cambodians account for 15� of Southeast Asian Refugees statewide,
� compared to 17$ in Ramsey County; and Laotians account for 14� of
Southeast Asian Refugees statewide, compared to 4� in Ramsey County.
r
� ETHNIC DISTRIBUTION OF S.E.ASIAN REFUGEES
Resettled in Minnesota as of November 1990
� (This wra/of 34,116 S.E.Asian refugces dou not include secondcry migranu.)
Ethnic Group
� Laotian II'��4,821
(1/%)
� Cambodian S,O11
(IS�)
� Vietnamese 11 933
(3�%)
� Hmong 12,351
f3696)
� 0 5,000 10,000 15,000
Number resettled in Minnesota
r .�.��..�.��...�.�.,�..�.��.�.�. .
,Iw�.wl,.w.p.Mt n..r.�s.G,.iu..
,
,
6. The following four tables illustrate the distribution of Asian,
, Hispanic, Black, and American Indian residents iiving in St. Paul
by census tract.
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Summary Demographics
�
Cambodians account for 15$ of Southeast Asian Refugees statewide,
compared to 17$ in Ramsey County; and Laotians account for 14� of �
Southeast Asian Refugees statewide, compared to 4� in Ramsey County.
�
ETHNIC DISTRIBUTION OF S.E.ASIAN REFUGEES �
Resettled in Minnesota as of November 1990
(This toml of 34,116 S.E.Asian�efugeu does not includt ucondcry rxigronu.) �
Et6nic Group
Laotisn �4,821 �
(1196)
Cambodian 5,011 �
(1s96)
Vietnamese 11 933 �
(3�96)
Hmong 12,351 �
. (36%)
0 5,000 10,000 15,000 �
Number resettled in Minnesota
��.�..�.o...,...�.,...,..a....... �
,,.�,..�„M,,,,..,�,,..�..o,.,.,..
,
. ,
6. The following four tables illustrate the distribution of Asian,
Hispanic, Black, and American Indian residents living in St. Paul �
by census tract.
,
,
21 ,
�
,
g�ary Demoqraphics
�
�
�
� , _ `�"...
"" m, �a �o�"�: aoe.oe �o�.m
# i i � ..�.,. _ s ��.� �
� £ '�
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< �� <�.
e.. � i a„
>: 7t0 j ��
��■ � �� 7py;' _,-�.; � 7t�.Ot
M �: .� qr :-> 7U'��� � i
� Ot� r'y'�M i14 ,: � .s.
i1� 7N ��, � '�,'�'K
) �t���, ]i/.Ot
i �GO # itt pt �7! �` :. . . �rir �� �� . �.rw
bt:�
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� ` � b ,,.o.,
�M � � � -... 1 �' ��� � �
� '3g S
Yt 767 � � �'t',�771 f''T � ]61 1,
M ���� $�' �" y 77�.W
, � :.' ..>�/ :
�Q �q �/4 �K �M �/'7 90/ �M i0 � 87�.01
� � � . ..�.,. �
� � ,���
� � � � �'�����
. �
� � �
�.�. �j� ,�,.
� �
M
Y7tD1 776 �
�L
1990 Census of Populalion
.��� ,� �
{ ``y ��w' St.Paul Census Tracts �
v;� r
d� ',�,
� *������' `K�R;�°f Distribution of Asian Residents j5
�,�
<u<� ;�;� � .':`;� ��
� �>. �i : ,..
:�..:�::.
�v?n�n •�x:�" +t 9
�s.,�: �:
<�,;: [< _ OvM 1000
,��::.
� S00•YY9
, `Y'.�'�`•;�.>: �00-�99
Q 200-2!i
Q l.�ts tlue 200
,
,
�
, 22
,
,
Summary Demoqraphics
,
�
�
� - � �
�`" � � � i �a ! �oa � �oe.o� � xe.ot �o�.w = �
001 f � JA� M � 707.OZ
O�r [\� ��� � . . �
d ��.�
�
�,y : � �„ �
s.
;:,,�.,, a,c �
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tiM\iY1 y'•
ou `".�,,,.w� o�z mo ou � ,;� me � �. '�`'r.r �
t t its w"'� a �
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� :"R„a.a �j
,� s
�
�a oa � oec �w xr �a x� xo �n �„ �r x`4°°#�'`� � f • :�
a � � � ���� � r��.ot �
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� � � w
� �
� �.���, ` �� • ��: <
.
,r ,,.r„ :.., .,..:;:.
� � �
l7�At Af �w
�L �.�.
�� i� 1990 Census ot Population �
� �~ St.Paul Census Tracts � �
� �°' Distribution of Hispanic Residents ��
� Owt 1000 pw Gn�u�Tnet �� �
. ;?�:'°"< �01•1000 pM Gnw�Tnet
Q 201�10o pv Gnw�Tnet ,
Q 200 0►Ms�pn Gnw�Tnq
�
,
,
23 ,
,
,
g�ary Demoqraphics
� .
,
,
� "".
,� , �{�.- ,�� .. .
; � . ' � "� oa.aQ �.w ,
� � �ot `r x�a� �.o¢
.. , > ....
� z :.�, '€ � �
Ow� � ,f..' ;� . i .���
��� z3 ;
�-�e � {�' � W
~ r��.M � �� �.°c����. . � 710 j ww
■ �1�.@
� �lf �� �� ,..:......� � �
��. i1! Ot� � 911 � Ot� 317
� 3N # 741 7r2 �i ..� �1i M
r,,. � . � a r:: �w�r.r � 01L01 �w�r�
, a d8�` �
� � � � � � $ � � � ]� yl`� ♦'bl r n� � SN.Ot � 04L02 OQ� -
i �° �
s . �• ��' ,., "� �,..o,
�
79) � :.-�~,..;�;� � ` � ��
�N � .
! � � � ' �
�a� � ; ��
, { �0 � 3��rL::Y�'�:',,, � g�� }c�i� .. ri �1 •
\sh
6 � ss� r.�.. �'+r ,��'�^ �
� ss� � � ��� �S �'��
f s+ � s � �� �� s
� •�r � � � _', ���.� �
� � �p �M �I6 OE! 7p 7M � p� e� �J�A1
� E � # 1 ! � } ° 4�"...
� � �
a..�. �° �� �:: = d : �$
� � � � .
� �
� .
��..�, � � �
•�
+� « 1990 Censua of Population ' �
� ; �
r � � S�Paul Census Tracts �; j � y` �
�
{ m� ' Distribution of Black Americans �� `y $i= � �$
, .. � ; : Ks
- a«,000 p.c.n,u.T..a
- SOGlM w pnaa Tnet
, � �o0�f�pK Gnaa Tnd
Q 204ZM y�C�an Tnd
Q ln�Ih�n 30D Nr Gnw�Tnet
,
,
,
, 24
,
,
Summar�r Demographics
. �
�
,
� ,
,�„ .
"" ' �oo �o► �' "�t ' ze.ox x�m �
,:
�o� � �o¢ jp� i w.+�""� 3: a� � ' ` � 'k �ozo. � �.m �
� � (Q� .� k��r . �� `.
�� � \ � . � .:�fl '� w
� .� <�. ."� -
�M �:Hydi;;.,.Mi.i � Ip �..�' . �.:l.:�:
!H .... 71�.07 �
r...... -� au y�„""zy''r� ..... 1° � �
.:.. �� JUKf 'ks � t1 �r.-'� t7
�� # �Z1 �'! '�71 :. 6�r�� ,,�,.�:� t5 �s rY �' �71�A1
�w. x '� � '�, % err �I� �l�1 � � r.r'a
� � �_' � F <f � � `�����z� �'� as at� ���,. . � � auox � Hzot y aw.a¢
�r" . ' � ""' ,
x4 x� � �n 9 ,, � �. w
w � j ,N �
$ `
'� i� � ��a'° �:.,,� ��€ ,�,�' .3:: � .n.
f � •.:.,
, ,,., .:
{ �0 �62 067 -�� � �60 . z,j^x i�' �71.02 _. . � ,
O V� '
Jly � J6! ��!R .;. , ° � �� , �. �
f a� � � xo ` ...r� �� �
� s
; � '� � � ,. n `
J71 . M. .�. �
7Q 7p 0i1 016 7M D/7�.; 7M J69 � ^ 'J1/A6��� rm . �
� l � '
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�� i� �k
rw �Vrr ����0 �..r.w }..
� ,
�7�.01 J76 � �w
�� � �
�+► t� « 1990 Census of Population � , � �
� �`' St.Paul Census Tracts : ,� , °' �
� � Distribution of Native Americans ' �
� '� �
_ Orw 120 p�r Gntus Tnet
a9
� 75/20 pn dnsw Tnet
� 5471 Mr pnws Tnet ,
O 3PIf pw Gnws Tnef . ,
QLNa tlan 70 p�r Gmus Tnd
,
,
,
25 ,
,
,
gummary Demographics
�
Following this Demographics Section, data are listed, divided up into
� the ten problem areas, that indicate the discrete Public Health
Problems currently found in the populations residing in Ramsey County.
�
,
�
�
,
,
,
�
,
,
,
�
�
,
, 26
,
,
Iniurv/Violence Problems/Goals
,
PROBLBM 1: Increasinq number of reports of child abuse, domestic
abuse, and abuse of the elderly and disabled**
, GOAL 1: To advocate and work towards a society free of child
abuse, domestic abuse, and abuse of the elderly and
, disabled
, PROBLEM 2: High number of deaths, disabilities, and Years of
Potential Productive Life Lost associated with motor
vehicle accidents
, GOAL 2: To reduce to a minimum the number of deaths, disabilities,
and years of potential productive life lost associated
, with motor vehicle accidents
, PROBLEM 3: High occurrence of deaths and disabilities associated with
childhood/adolescent unintentional injuries
, �GOAL 3: To reduce to a minimum the incidence of deaths and
disabilities due to unintentional injuries in persons of
all ages
, -----
PROBLEM 4 : High incidence of deaths and disabilities due to
, unintentional injuries in persons of all ages, and persons
between the aqes of 15-24 in particular
, GOAL 4: To reduce to a minimum the incidence of deaths and
disabilities due to unintentional injuries in persons of
all aqes
� -----
PROBLEM 5: Increasing incidence of suicide and homicide deaths among
, people aqes 15-24
GOAL 5: To reduce the incidence of suicide and homicide deaths
, among people ages 15-24
, ** Identified as one of thirteen Hiqhest Priority Problems by St.
Paul-Ramsey County Community Health Services Advisory Com�nittee
,
, 27
,
. ,
Injury/Violence Rey Data
,
1. There were a total of 1,970 suspected cases of child abuse in
Ramsey County in 1987; of this total, 659, or 33$ were
substantiated. ,
2. There was a 30� increase in Ramsey County in the number of
substantiated abuse cases between 1982-1987. ,
3. There were 5.4 substantiated cases of abuse per 1,000 children in
Ramsey County in 1987. �
4. Caseload data from Ramsey County Human Services Department:
0 22,301 intake screenings in 1988. ,
0 2,963 case assessments in 1988: 1,143 child abuse, 1,820
child welfare.
0 3,003 cases disposed of in 1988: 2,443 handled in intake or ,
assigned to other program, 560 to child protection.
0 955 child protection cases open as of 12/88; 44 child
protection workers, for average of 21.7 cases/worker. �
0 29 high risk cases referred to child protection between 10/88-
1/89.
0 66 terminations of parental rights in 1988.
0 183 child protection petitions filed in 1988. ,
5. Data from Minnesota Department of Health: ,
o During 1986 there were 2,157 children on child abuse/neglect
reports, and 679 substantiated abuse/neglect reports in Ramsey
County. ,
6. Motor vehicle injury as a cause of death results in the second �
highest number of Years of Potential Productive Life Lost (YPPLL)
in Minnesota, resulting in over 20,000 YPPLL in 1988.
7. In 1988, motor vehicle injury deaths accounted for 42 (34$) of 128 ,
fatal injury deaths in Ramsey County. Seven of these deaths
occurred in persons below the age of 20 years, with the remaining
35 deaths in persons above the age of 20. ,
8. Unintentional injury was the leading cause of death in Ramsey
County in 1988 among children between the ages of 5-14 years, �
accounting for 10 (56�) of 18 deaths.
,
,
28 ,
,
,
IniurY/Violence Rey Data
, �
9. Unintentional injury was the the second leading cause of death
, among persons between the ages of 15-24 years, accounting for 11
(29�) of 38 deaths.
10. Suicide was the leading cause of death in 1988 among Ramsey County
, residents between the ages of 15-24 years, accounting for 14 (37� )
of 38 deaths in that age cohort.
� 11. The following graphic illustrates that during the years 1980-1988,
suicide and motor vehicle deaths were the leading causes of
violent death among Ramsey County residents, followed by
, accidental falls and homicide.
, DEATHS DUETO VIOLENCE,1980-1988
RAMSEY COUNTY RESIDENTS
Vlol�ni Caus�of D�ath
� All oTher '
................i.......•••••••••.�••••...••-......:................:................?.......•••••••••;•••.............
, Homicide
.............:...............q............. ........... --••••••••• •.......... ...........
� Aocidental fails
........__�._.....__.._:...............�...._...... .......... ........... _......•••-
, Mota vehide
................<_...........«..6..........«....�..............»:................:................:................
� �
� 0% 9% 10% 15% 2096 2S% 3096 35%
P�re�nt of Vlol�nt D�atbs
� ar.nw.arsiova�wa.w�xn+
sai,nee: r.r e�r.r�rrw s�rrs
,
,
�
, 29
,
,
In-iurv/Violence Ob]ectives/Methods/Svaluation
,
Ramsey County Public Health Department
o OBJECTIVB 1: BY DBCBMBBR 31, 1995, TO BLIMINATB ANNUAL ,
INCRBASBS IN TH$ INCIDSNCB OF SUBSTANTIATED CHILD
AND DOMBSTIC ABUSB CASBS AND TO DBCRSASB BY 10$ ,
FROM 1988 DATA 1rIORBIDITY AND MORTALITY ASSOCIATBD
WITH UNINTENTIONAL INJURY.
(PROBLBMS 1, 3, 4) �
Method la: Coordination of community partnerships that �
are designed to promote the health of Ramsey
County residents and strengthen families.
Evaluation la: Documentation of partnerships developed, ,
meetings held, and outcomes/system change;
analysis of data on incidence of abuse and ,
unintentional injury.
Method lb: Provision of Public Health Nursin home ,
9
visits to enhance parenting and family coping
skills, and identify and intervene where �
appropriate in cases of potential abuse.
Evaluation lb: During 1988, 10,904 home visits were provided
to 2,047 clients in Hiqh Risk - Growth and ,
Development category (category includes
several target groups/services, including
child abuse/neglect. ) �
Method lc: Implement a planning team which will include ,
community clinics, other community providers
and advocacy qroups, and Ramsey County
Community Human Services Department Childrens �
Services staff to analyze and implement as
appropriate a series of alternative service
delivery and coordination strategies which �
might include:
1. Develop/purchase and disseminate simply ,
written materials re: child development,
parenting education (development of trust,
autonomy, cognitive/moral/conscience
development) ,
30 ,
,
,
In-iurv/Violence Obiectives/Methods/Evaluation
,
2. Develop annual Spring Public Relations
campaigns in conjunction with other agencies
, (MN Safety Council, etc. ) on water and
bicycle safety and other topics as
appropriate; develop schedule of materials to
, be given out on PHN home visits (water safety
& bike helmets in Spring, safe travel tips in
Winter, etc. )
� 3. Develo educational campaiqn regarding sexual
P
abuse, harassment and date rape among
� teenagers: collaborate with Sexual Offense
Services to do as much as possible to promote
their services; collaborate with Planned
, Parenthood to disseminate their new brochure
on date rape; explore having Department staff
see Illusion Theatre's Touch, etc.
, 4. Continue/increase collaboration on Ramsey
County Family Violence Initiative, including:
advocating for stronger community support for
, women who have used the legal system to deal
with a violent relationship and help them to
avoid returning to an abusive relationship;
, addressing social values which do not provide
for a safe environment for women, and
advocating for statewide media campaigns to
address and change values regarding abuse of
, women and children; and working to change
Ramsey County community standards regarding
what is an acceptable level/incidence of
, neqlect of children, defininq and expanding
Child Welfare/Advocacy efforts in the County.
, 5. Work with leqal system & Lao Family, and
other appropriate organizations to
address increasinq violence and gang activity
in Among community; increase staff awareness
, of these issues and develop protocols &
procedures regarding staff safety.
� 6. Work with schools, and other appropriate
orqanizations (current programs underway in
White Bear Lake & Roseville) on campaign for
, creative nonviolent conflict resolution;
advocate for the Minnesota Public Health
Association to adopt this campaign as a part
of its statewide agenda/campaign.
,
, 31
�
,
Iniurv/Violence Objectives/Methods/$valuation
,
7. Advocate to have parenting education as
permanent part of school curricula. ,
Evaluation lc: Information will be collected on planning
and outcomes regarding the strateqies
outlined in Method lc. ,
Method ld: Public Health expertise is provided to the ,
development of care plans and interventions
for abused children in Ramsey County through
PHN staffing of the Ramsey County Child Abuse ,
Team and for vulnerable adults in Ramsey
County through PHN staffing of the Community
Vulnerable Adult Team. ,
Evaluation ld: Information is collected on PHN staffing of
Teams, care plans and interventions developed ,
and recommended, and outcomes.
,
o OBJBCTIVS 2: TO ASSURB BMBRGBNCY M$DICAL SBRVICBS TO 100$
OF RAMSBY COUNTY RBSIDBNTS. �
(PROBLBMS 2, 3, 4)
Method 2a: Ramse Count throu h the East Metro EMS �
Y Y� 9
Radio Joint Powers Board, provides funding
for the ambulance-to-hospital communications ,
in Ramsey, Washington, and Dakota Counties.
Evaluation 2a: Data are collected on the utilization and ,
effectiveness of the 8MS system. In 1989,
the EMS Radio System handled more than 26,000
calls.
----- ,
o OBJECTIVB 3: TO ASSURB SAFB MAINTBNANCB PRACTICES AT 100$ OF ,
PUBLIC SWIMI�IIING POOLS IN SUBURBAN RAMSBY COUNTY.
TARGBT POPUI.ATIONS ARS OWNERS, OPBRATORS, AND ,
PATRONS OF PUBLIC SWIMl�IING POOLS.
(PROBLEMS 3, 4)
,
32 ,
�
,
in7ury/Violence Ob7ectives/Methods/Bvaluation
,
, Method 3a: Inspection of public pools, includinq
analysis of water samples to assess water
quality and inspection of safety equipment
, and signs.
Evaluation 3a: Data are collected on nwnber of public
, swimming pools in Suburban Ramsey County
regulated and total number of inspections.
During 1989, 130 public swimming pools in
Suburban Ramsey County were regulated.
, Indoor pools were inspected monthly and
outdoor pools were inspected biweekly during
the months of operation. Total number of
� inspections was 1,079.
, Method 3b: Each public pool is required by County
ordinance to have a certified operator. An
annual pool operators course is conducted to
� educate and certify operators.
Evaluation 3b: Data are collected ensuring certification and
, up to date training of operators.
� (NOTE: Also see Goals, Objectives and Methods contained in Ramsey
County Formula Maternal and Child Health Special Projects
, Grant. )
,
�
,
,
,
, 33
,
Injury/Violence ObiectivesfMethodsfEvaluation ,
St. Paul Division of Public Health �
• OBJECTIVE 1: TO ELIMINATE ANNUAL INCREASES IN THE OCCURRENCE OF
INJURY, ABDSE AND VIOLENCE AITHIN ST. PAUL, BASED
ON THL NUMBER OF SUBSTANTIATED CASES IN 1988, BY ,
DECEMBER 31, 1995.
(PROBLEMS 1, 3, 4)
---- ,
Method la: Coordination of Division staff and utilization of
a multidisciplinary team (nurse, social worker, ,
inspection staff) currently help to identify
current and potentially harmful situations, ensure
that appropriate referrals are made and, as ,
necessary, assist in the removal of individuals
from harmful situations .
Evaluation la: Data are collected to determine the number of �
situations where the multidisciplinary
intervention was utilized, and referrals are
tracked to help ensure followup by clients ,
and/or other agencies.
Method lb: Referrals to various assistance ro rams �
P g
including parenting classes, crisis nurseries,
shelters, and other community resources are �
provided to St. Paul Division of Public Health
clients.
Evaluation lb: Data are collected on the number and types of ,
referrals made, and may be monitored to
ensure they were completed. ,
Method lc: Continue to provide community education and ,
resources on elder abuse to community groups; and
work with the Advisory Committee on Aging to make
recommendations to the Mayor' s office to reduce �
elder abuse and other problems the elderly
population face.
Evaluation lc: Data are collected on presentations given and ,
recommendations made.
---- ,
�
34 ,
�
, Injury�Violence Objectives�MethodsfEvaluation
, Method ld: Education to community groups and students in
schools on sexual abuse and violence is provided
in coordination with reproductive health ed.
� Evaluation ld: Data are collected on education provided, as
well as monitoring sexual violence indicators
, and data.
� Method le: Educational brochures are translated and developed
in various Southeast Asian and other non-english
languages. The feasibility of producing
, videotapes in non-english languages in this area
will be explored.
, Evaluation le: Receptivity and attitudinal changes based on
materials can be surveyed, as well as data
collected to indicate brochure/material
development and distribution.
� ----
� Method lf: Continue to identify appropriate settings to
promote the use of Buddy Rock materials, an
educational project focused at preschoolers
addressing injury prevention and self esteem.
, Evaluation lf: Data are/will be collected to evaluate
appropriateness of settings where the
, project is used and estimated
effectiveness/receptivity.
, od 1 : Continue to rovide direct ro rammin to children
Meth g p P 9 g
utilizing Project H.A.P.P.Y. which has educational
, components focused on self esteem, chemical
health, nutrition, lifestyle choices, abuse,
suicide and environmental issues; and investigate
, expansion of sites to additional community
agencies, park and recreation centers and other
appropriate settings. (Currently provided at SEA
, Access Project) .
Evaluation lg: Data are/will be collected to evaluate
appropriateness of settings, receptivity and
, attendance.
,
� 35
,
InjurXfViolence ObjectivesjMethodsfEvaluation ,
Method lh: Staff from the SPDPH is actively involved with the ,
Mayor' s Advisory Committee on Family Violence,
evaluating issues, policies and procedures related
to family violence and the aspects of prevention,
legal/judicial services, and shelters/medical �
response/support systems. Recommendations will be
made to the Mayor on how to better address the
issue of family violence. ,
Evaluation lh: Recommendations of the committee will be
followed to identify which ones are approved �
for implementation by the various agencies
and the Mayor.
---- ,
Method li: Grants will continue to be written for funding of
safety projects including water safety and ,
passenger safety.
Evaluation li: Funding of grant proposals will be evaluated,
and possible sources of funding will continue �
to be sought.
Method 1 ' : Public swimmin ools are ins ected to ensure that �
7 J P P
physical structures and environments are safe, and ,
that safety apparatus is available.
Evaluation lj : Data are collected on the results of
inspections, and through follow up �
inspections, staff ensure that hazards have
been corrected.
---- ,
• OBJECTIVE 2: TO DECREASE BY 5� THE INJORIES REQUIRING MEDICAL
ATTENTION, OCCURRING IN 122 LICENSED DAY CARE ,
FACILITIES, SERVING 6,000 ST. PAUL CHILDREN, BY
DECEMBER 31, 1995.
(PROBLEMS 3, 4) �
Method 2a: Fifteen licensed St. Paul day care centers are ,
visited each month to help ensure that the
facility is safe and that risk of injury is
minimized. Education of staff is performed. ,
Accidents requiring medical attention are reported
to the Division of Public Health.
�
36 ,
�
, InjuryfViolence ObjectivesfMethodsfEvaluation
, Evaluation 2a: Data are collected on the number of accidents
occurring in licensed day care centers .
Specific education may be focused on areas
that are determined to be problems.
� ----
, • OBJECTIVE 3: TO REDUCE BY 10$ THE MORBIDITY AND MORTALITY RATES
OF 1988 DUE TO MOTORVEHICLE AND BICYCLE IISE BY
DECEMBER 31, 1995.
� (PROBLEMS 2, 3, 4) -
� Methods 3a: Continue to promote the use of seatbelts, carseats
and helmets through the development of brochures
and booklets, and referrals to various local
, passenger protection and injury prevention
programs .
Evaluation 3a: Reported data on injury and death due to
� motorvehicle and bicycle injury is reviewed
to identify impacts of education efforts by
the SPDPH and many other agencies .
� ----
�
,
,
,
�
�
�
�
, 37
�
�
Injury/Violence Inventory
,
o Ain Dah Yung Shelter Center, 1089 Portland Avenue, St. Paul
o Amherst Wilder Foundation - Division of Services to Children and �
Families, 919 Lafond Avenue, St. Paul
o Casa de Esperanza, St. Paul
o Children's Home Society, Crisis Nurseries
o Consumer Product Safety Commission, 316 N. Robert Street, St. Paul �
o Crisis Intervention Proqram - St. Paul Ramsey Medical Center, 640
Jackson Street, St. Paul
o Emergency Social Service, 100 South Robert Street, St. Paul �
o Family Violence Network, PO Box 854, Lake Elmo
o Health Care for the Homeless Project, 153 Concord, St. Paul
o Midwest Children's Resource Center, St. Paul
o Minnesota Passenger Protection Program, 509 University Ave. , St. �
Paul
o Minnesota State Fire Marshall Division, 450 N. Syndicate St. , St.
Paul �
o Minnesota Head Injury Association - Chapter of National Head
Injury, 1313 5th Street SE, Minneapolis
o Minnesota Institute of Public Health (Car Seat Loaner Program) , �
2829 Verndale Avenue, Anoka
o Minnesota Committee for the Prevention of Child Abuse, 1821
University Avenue West, St. Paul
o Minnesota Coalition for Battered Women, 570 Asbury Street, St. Paul �
o Minnesota Safety Council, 474 Concordia Avenue, St. Paul
o Mothers Against Drunk Driving, 450 North Syndicate Street, St. Paul
o Midway Family Service and Abuse Center, 435 Aldine Street, St. Paul �
o Midwest Center for Development, 2550 University Avenue, St. Paul
o Minnesota Snowmobile Safety Program, 500 Lafayette Blvd. , St. Paul
o Parents Anonymous, 265 Oneida Street, St. Paul
o Ramsey County Community Corrections and Community Hwaan Services �
Departments, 160 E. Kellogg Blvd. , St. Paul
o Resources for Child Caring, 450 N. Syndicate St. #5, St. Paul
o Sexual Offense Services of Ramsey County, St. Paul �
o St. John's Hospital Northeast (Infant Seat Loan Program) , 1575 Beam
Avenue, Maplewood
o St. Paul Intervention Project, 435 Aldine Street, St. Paul �
o St. Paul Police Department
o St. Paul-Ramsey Medical Center Poison Control, 640 Jackson, St.
Paul �
o Women's Advocates, 584 Grand Avenue, St. Paul �
�
,
�
38 �
�
�
,
�
,
�
� . � . � � .
i
�
�
�
�
�
i
�
�
�
�
�
�
r �
Maternal-Child Bealth Problems/Goals
,
PROBLBM 6: High occurrence of abuse and neglect of children being
born to large numbers of sinqle women and/or adolescents,
� as well as parents who are actively abusing/addicted to
chemicals **
� GOAL 6: To reduce to a minimum the incidence of births to
adolescents and/or parents who are actively abusing/
addicted to chemicals, and to advocate and work towards a
� society standard free of child and domestic abuse
� PROBLEM 7: High number of children at risk for injury and illness due
to various day-care and school safety and hyqiene issues,
i.e. food safety, communicable disease, lead, and
� structural/equipment concerns *�
GOAL 7: To eliminate the risk for injury and illness due to
various day-care and school safety and hygiene issues
� -----
� PROBLBM 8: Occurrence of late or no entry into prenatal care,
particularly in communities of color **
� GOAL 8: To develop universal understanding of the importance of
early prenatal care, and to assure equal and fully
adequate access to prenatal care for all residents of
Ramsey County
� -----
� PROBLEM 9: Hiqh rate of unintended pregnancy amonq teens **
GOAL 9: To reduce to a minimwa the incidence of unintended
� pregnancy among teens
� PROBLEM 10: Lack of parenting skills for child care/parenting
GOAL 10: To foster and assure positive parenting skills for child
� care/parenting
� ** Identified as one of thirteen Hiqhest Priority Problems by St.
Paul-Ramsey County Community Health Services Advisory Committee
r
� 39
�
�
Maternal-Child Health Problems/Goals
�
PROBLEM 11: Hiqh prevalence of high risk & premature births
GOAL 11: To reduce to a minimum the incidence of high risk & �
premature births
----- �
PROBLEM 12: Increasing incidence of low birthweight births among �
Southeast Asians; high incidence of low birthweight births
among Blacks and American Indians; high birth rates among
Southeast Asian and Black teenagers
GOAL 12 : To develop universal understanding of the importance of �
early prenatal care, and to assure equal and fully
adequate access to prenatal care and family planning �
services for all residents of Ramsey County
PROBLEM 13: Prevalence of chronic illness/disabilities associated �
with genetic/metabolic disorders, developmental delay,
injury �
GOAL 13: To reduce to a minimum the incidence of chronic illness/
disabilities associated with genetic/metabolic disorders, �
developmental delay, and injury
PROBLEM 14 : Hi h infant death rate amon hi h risk rou s• incidence �
9 9 9 9 P ,
of Sudden Infant Death Syndrome deaths
GOAL 14 : To develop universal understanding of the importance of �
early prenatal care, and to assure equal and fully
adequate access to prenatal, postpartum and pediatric care �
for all residents of Ramsey County
PROBLEM 15: Prevalence of ediatric asthma �
P
GOAL 15: To reduce the incidence of pediatric asthma �
�
�
40 �
, - �
�/ / �3
r
Maternal-Child Health Rey Data
�
1. Between fifty and seventy percent of reported child neglect cases
, in Ramsey County in 1989 involved chemical abuse. (Drug Abuse
Prevention Resource Council Report. ) (Also see child abuse data
under Problem 1. )
� 2. Infants and toddlers attending day care are at greater risk for
chronic or recurrent otitis media, bacterial meningitis,
dehydration due to diarrheal diseases, and serious respiratory
� tract infection. (JAMA, April 18, 1990)
3. During 1988, a total of 463 women in Ramsey County gave birth
after havinq either no prenatal care or having started prenatal
� care in the third trimester of pregnancy. This figure is an
increase of 127, or 38$ from the comparable figure of 336 late or
no prenatal care births in 1980.
� 4 . Six percent of all births in Ramsey County in 1988 were to women
who had either no or late prenatal care, compared to 4.4$ in 1980.
� 5. Comparisons of Black and Southeast Asian infant mortality rates
with the total population:
� Comparative Infant Mortality Rates, 1984 and 1988:
� Group 1984 1988 � Change
Total, All Ramsey County 9.6 8.8 -8.5�
Total, St. Paul 10.5 10.3 -1.8�
Total, Suburban R.C. 8.2 6.3 -22.4$
� Blacks, All Ramsey County 15.0 21.9 +46.3�
Blacks, St. Paul 14.3 21.2 +48.4$
� Blacks, Suburban R.C. 20.8 27.0 +29.7�
SEAs, All Ramsey County 5.5 7.3 +32.3�
� SEAs, St. Paul 6.9 8.6 +24 .3$
SEAs, Suburban R.C. N/A N/A N/A
� 6. Data on women receiving in late or no prenatal care:
� Late or No Prenatal Care, 1984 and 1988
Geographic Area 1984 1988 � Change
� All Ramsey County 4.9� 5.6� +14 .3�
St. Paul 6. 1� 7.5$ +23.0�
Suburban R.C. 2.9� 2.5� -14.2$
�
r41
,
�
Maternal-Child aealth Rey Data
731 ir hs to adolescents in Ramse Count in 1988 a ,
7. There were b t y y ,
decrease of 12�k, or 99 births when compared to 1980. Nine percent
of all births in the County in 1988 were to adolescents. �
8. There were 582 births to single adolescents in Ramsey County in
1988, an increase of 15$, or 77 births when compared to 1980. �
Seven percent of all births in the County in 1988 were to single
adolescents.
9. In 1986, 2.5� of all women giving birth in Minnesota were below 18 �
years old, 3.3$ of all women giving birth in Ramsey County were
below 18 years old, and 4.5 � of all women giving birth in St.
Paul were below 18 years old. �
10. The teenage abortion rate in Ramsey County was 47. 1� in 1988:
59.7� in Suburban Ramsey County, and 42.9� in St. Paul. �
11. Statewide in 1988, 22.4� of all births were high risk based upon
MDH risk criteria; in Ramsey County, 23.7� of all births were high
risk: 27.0$ in St. Paul, and 18.3� in Suburban Ramsey County. �
12. Statewide in 1988, 6.3� of all births were premature; in Ramsey
County, 6. 1$ of all births were premature: 6.9� in St. Paul, and �
4 .8� in Suburban Ramsey County.
13. In 1988 in St. Paul, 25.7$ of all births to Black mothers were to �
women under 20 years of age, while 17.4$ of births to Asian
mothers were to women under 20 years of age.
14 . In Ramsey County in 1980, 6. 1� (467 of 7,626 births) of all �
infants born were low birthweight; in 1988, 5.4$ (445 of 8,276)
were low birthweight.
15. Nationally, SIDS is the third leading cause of infant mortality �
(following birth defects and prematurity/respiratory distress
syndrome. )
16. In 1983 in the U.S. Native American population, SIDS was the �
second leading cause of infant mortality; among Blacks, SIDS was
the third leading cause of infant mortality; among Hispanics and �
Asians, the fourth leading cause.
17. Between 1980-1988 in the City of St. Paul, the overall infant �
death rate was 10.4 per 1,000 live births. Among Whites, this
rate was 9.6/1,000; among Blacks, the rate was 21.9/1,000; among
Southeast Asians, the rate was 7.8/1,000.
�
�
42 r
�
,
Maternal-Child Health Rey Data
�
18. Between 1980-1988 in the City of St. Paul, the overall neonatal
death rate was 6.3 per 1,000 live births. Among Whites, this rate
, was 6. 1/1,000; among Blacks, the rate was 11.8/1,000; among
Southeast Asians, the rate was 4.1/1,000.
, 19. Between 1980-1988 in the City of St. Paul, the overall fetal death
rate was 7.3 per 1,000 live births. Among Whites, this rate was
6.5/1,000; among Blacks, the rate was 11.3/1,000; among Southeast
� Asians, the rate was 9.6/1,000.
20. Between 1980-1988 in the City of St. Paul, the overall perinatal
death rate was 13.6 per 1,000 live births. Among Whites, this
� rate was 12.6/1,000; among Blacks, the rate was 23. 1/1,000; among
Southeast Asians, the rate was 13.6/1,000.
� 21. The tables on the following pages graphically illustrate MCH care
trends and issues in Ramsey County, including:
, o Total numbers of resident births broken out by race and
trimester that prenatal care began, demonstrating significantly
higher rates of late or no prenatal care among Blacks, American
Indians and Asians than among Whites.
� o Live births, out-of wedlock births, and births to unmarried and
teenage mothers by Health Planninq Area and race, which
� demonstrate that the highest concentration of teenage mothers
in St. Paul are in the Summit-Dale, Dayton's Bluff and Phalen
Park neighborhoods, and the highest concentration of teenage
mothers in Suburban Ramsey County in the cities of White Bear
� Lake, Roseville and Maplewood. When these figures are broken
out by racial category, the greatest pro�ort�ion of teenage
births occur amonq Blacks, followed by American Indians,
� Asians, and Whites, while the qreatest number of teenage births
occur among Whites, followed by Blacks, A— s a s, and American
Indians.
, o Trends in infant mortality from 1980-1988 in St. Paul, which
show an infant mortality rate of 21.9 among Blacks, compared to
9.6 among whites and 7 .8 among Southeast Asians during the same
� period; as well as overall infant mortality trends for Ramsey
County which show infant mortality rates of 10.4 for St. Paul,
9.7 for the County as a whole, and 8.7 for Suburban Ramsey
� County; and
o A table listing causes of death in Ramsey County children under
, age five in 1988, which lists conditions originating in the
prenatal period, congenital anomalies, signs, symptoms & ill-
defined conditions, and SIDS as the leading causes of death in
this age group.
,
, 43
RAMSEY COUNTY RESIDENT LIVE BIRTHS �
By Race and Trimester Care Began, 1988
�
Trimester Care Began
Race 3rd or ,
None Third None
Number ,
TOTAL.. 463 391 72
W hite....... 192 151 41
Black....... 63 52 11 �
Indian...... 17 14 3
Asian....... 176 167 9
Other....... 15 7 8
Percent �
T O T A L.. 6.74'0 5.69'0 1.09'0
W h i t e....... 3.49'0 2.7g'o 0.74'0 �
B 1 a c k....... 12.8g'o 10.69'0 2.2g'o
I n d i a n...... 18.1 g'o 14.99'0 3.23'0
A s i a n....... 29.8g'o 28.3g'o 1.Sg'o
O t h e r....... 16.14'0 7.Sg'o 8.69'0 �
r
LIVE BIRTHS WITH NO PRENATAL CARE �
Ramsey County Residents, by race, 1988
% with no care
4.0% �
3.2 96 ,
3.0 96 ...........................a...........................:•••••.... ........-0.....•••••••.....•••...•••-
2.2 96
. �
2.0% .�......�.......,,..,.. }•;., • ,,.........n.........
,�:� c�.� m �
.: ����4+s 1�570
:rti�.i•�
�M1. 4.C,`?� ���
t:�i`;�{,. t�
_ .,v .
�:��?.C�, .;jrr.v.�
: �`%•• : •:
:
1.0 96 ' . .•� ... ... ....
.........:.........'r�:� . ::;°••:
....."'.......... ., ........y........ r ... ...""
�.7�7 ' +�
. �, 4.,.
tr. � {� t �
-..`•' • ���
� h'� ..'.raG ~�i
V\ �'
:\�t.,; .>�+> jrfi
�.��7 ,
White Black Indian Asian
Race
,
Souror. binn�aot�C�rH�r lor FNdM SeuiOp
44 ,
,
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Maternal-Child Health Rey Data
�
NUMBER O F LIVE BIRTHS, 1980-1988
� Ramsey County Health Planning Areas
, Macaleate� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Summit-Dal,e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dayton's Bluff • ._.._......-• ••.. .••• •••• •••• .... .... .. .....
! White Bear Lake •• ••••-• ••••.. .... .. ........ •••:-•.' • -••-• •• •.......••-.... .......... .. .. ........ .. ..-•-• •-
Phalen Park _ .�:. :.:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
� Maplewood . . . . . . . • • • • . ' ' . . . . . . . . . . . . . � . . . . . . . ; . . . . . . .
Roseville
Rice Street . . ` . . ' .... .. .. .. .. ..
... .--- �--- .. .--•-• --.. .. .. .--• •..... .. ...... .. . . .. ...... .. .. . . .
� ComoPark . , _ . . - • - - • - • . .. . . . . . . . : . . . . . . . : . . . . . . . : . . . . . . .
Arden Hilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Shoreview . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . .
� NewBrighton . . . . . . . . . - • - • • • • • • • • • • , . . . . . . . . . . . . . . . . . . . .
Riverview . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hazel Park . . . . . . . . . . . . . . . . . . . . . . . . . . . t . . . . . . . ... . . . . . . .
� Thomas-Dals . - - - - • - - . . . . . . . . - - - • . . . . . . . . . .:. . . . . . . . : . . . . . . .
WestSeventh . . . - • • • . . . . . • • • • - • • • • . . . . . . . . . . . . . . . • • • • • •
� HighlandPark . . . . - - - • - . • . • . . . . . ; '. . . . . . . : . . . . . . . : . . . . . • -
Moundview
North St. Paul . ', ' ` ... .. .. .. .. ' . .. .. .. .. .. .. .
.. .. .. .... .. .. .. .......... .. .. .. .... ........ . . . . .
� �Hayden Heights . . . . . . . . . . . . . . . : . . . . . . . : . . . . . . : . . . . . . . . . . . . . .
VadnaisHeights , , , , , , , , , , , , , ,
Hamiine . . . . . . . . . . . . . . . : . . . . . . . . . . . . . : . . . . . . . . . . . . . . .
, Falcon Heights . . . . . . . . . . . . . : . • . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Battle Creek � : : . .. .. .... .. .. .... .. .. .. .... ....
M� Airy . . ..:. :. :.:. . • :• • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
� Littte Canada . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . , . . . . . .
St. Anthony Park . . . . . . . ' . . . . . . . . . . . . . . . . . . . . . : . . . . . . . : . . . . . . .
Midway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . : . . . . . . .
, North Oaks . .. ........ .... .... ...... ........ .............. : ........ .... . : .......... .. .. ....... .. .....
Downtown � ' • •
� 0 1000 2000 3000 4000 5000 6000
,
,
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�r.
Maternal-Child Health Rev Data
��
NUMBER O F OUT-OF-WEDLOCK LIVE BIRTHS, 1980-1988
�
by Ramsey County Health Planning Area
Health Planntng Area ,
Summit•Dals �
................... ....................f.."'..._............ t"'.....................�"'...............""'""'..............__ �:
... .__..
Thomas-Dal�
••• •••.. ..... . .
DowMOwn
Riv�rvNw • . .
' •••••-•••••.............
.......................................•--••••••:........................�..._.....•••-........... ....._...•••-.........--
Mt.Airy ..... ....................
".................................."'.........�._.............. ...�."'".....""".........p....................... .. .-
Dayton's BIWf ,
......................•••••......................................---•....;...__............ ,
Ph�Nn Park
........................_..........-_•_•••...+...•••...._.....••••••.:..••••••••_-...........:..••••••••...................._................
Riw Stn�t . ' .
.................-•••................................._................:........•••_•-••••_--:_...••••••••••••••......•••••••........•_•••..
W�st Ssv�nth '• ......_....•••..... ,
....................""""'......_...""""....i....................."'1"""'....""""'....�...................""' " ...
a.na cn.k � .......................
Hu�l Park ...._....•••••.... ................. .......................••....._•••-•••.......+'_..........••••••• .....•••••••••._...
.. ..... ....••• . ,
Hayd�n FbipMs � ' :
••••............... .....................�..._...................:....._..................;........_.............._ ...•••.............. ,
H�mllne �� : f ...................
...............••-......._................•••...+.•••--.................s.._.............._......:......._.........;......... ..
MldwaY • ........••••••.........i--•••••......••••_
��� .
.
.
....•••-••••.........................••••...---.i..........•••••••......:. ....._......••••-••••........
LIriNCanad� i........................±........_............. ........._............••.
.................................•••...........•g•---....................
MapNwood : � �
•-••.....•-•••••...............................:....._............_....�...._...................+........••-.....................................; �
Norlh St.Paul , i i
Macal�st�r � '
_.......""....... .........""'......4........."'...._.... ................... ......."'......... ...................
.. .. . ...�.. �
"' . . .
MoundvNwi i.••.................».i........_...............•••.....................
"................. .....................p.....................
... ..... ....
Como Pnic E ` i
Nsw Briphton ' ' � �
•••......................................................................*.......................;................................................
Hlphland Park ; i i ........................
................... ................... .................."'p'......................p...................._
.. ..... ......
� Whit� Bs�r Lak� E : :
•-......._..-•-•... ..••••...............�.......................:.......................;..-..................... ..•••............ �
... .....
Rowvill� i � ° ... ..
•••••-•.....•••.................................t.......................:_.......................�...
Vadnals HslpMs : ' •
.... •••••....... .....................?..................... ......__............-:•................... ...................
... ... ..... ...... . .
ArdenHllls �........................4........••••••••......•+•••.................... .
....................... ........................: . , ...._..................
ShonvNw ...........••••••. ...•••••.........•• . ••••-•--•••••••••.. . ...•••.......-•-•_ .....••••_•••••••• •••••••••.......... ,
................... .•••............... . .................__..r.......................+.............................................
Norlh Oaks :. �
.. .._.. ••• •• ••;••• •. ..
St.AMhony Puk .......................i.................._....� i
................. ....................._.................... ............._.....
Falcon HsiyMs
0 50 100 150 200 250 30C �
Number of O W Live Births
�
ST.PAUL DNlS/ON OF PUBUC HEAiTH
SOURCE: AMrsol�Gna Ibr HwM SewaMu �
IB: .�M�fiGf
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46 ,
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Maternal-Child Health Rey Data .
�
� ,
� RAMSEY COUNTY RESIDENT LIVE BIRTHS
born to Unmarried and Teenaged Mothers
by Health Planning Area of Residence, 1988
iP�rc�M of Wtal Iiv�births
HEALTH TOTAL TOTAL
PLANNING LIVE Unm�rrlad Under Ap• Totd TEEN
� AREA BIRTHS moth�rs �p� 76 18-7� t��m MOMS
SAINT PAUL
, Nn.ary.......................... �s� 32�� 2.sx �s.sa,c �e.�% r�
Thomes-Dale................. 308 43.5% 1.6% 1&99L 78.59G 57
Summfl-Dale.................. 541 40.7% 2.296 75.SX 17.7�G �
Deytons Bluff................. 518 39.7% 2.39G 14.17G 18.49L �
Rice Street..................... 388 30.7% 1.99L 13.7% 15.8% 57
Povervlew....................... 315 35.9% 1.39. 13.7X 15.09G 47
� Phelen Park._......._...... 533 39.09G 0.29L 13.79L 13.9% 74
Flazel Perk..................... 241 26.1% 0.4% &5% 9.9%; 24
Hayden HeigMs...._....... 196 25.5X 1.59L 7.79L 9.2X 18
Beltle Creak.................. 132 30.39G 2.3lL &8% 9.19L 12
Hemline......................... 184 27.29L 0.59L 7.1% 7.69G 14
� West Sevenlh................ 2�B 24.59L 0.09G 6.39L 6.39G 17
Como Park.................... 3B3 17.09L O.WiL 5.SX 5.5X 27
Macalester..................... 614 1&0% 0.5% 4.8% 5.1% 31
Highlend Perk............... 235 11.1X 0.096 4.3% 4.3% 1�
St.Mthony Perk............ 83 3.896 0.0% 24% 24% 2
� Midway.......................... 43 20.976 0.09L 23K 23% 1
Downtown...................... 20 60.09G 0.09G 0.0X 0.09L 0
RAMSEY COUNTY SUBURBS
� North St.Paul................ 168 18.1% 0.89G 9.09G B.BX 16
Nbundsvlew................... 224 20.1% 0.09G &OX 8.07L 18
Llltle Canede.._............. 128 27.3% 0.0% 5.5% 5.5% 7
New BrlpMon............._.. 2�i 127'�G 0.4% 4.9X 5.3% 75
� Rosevllle........................ 419 11.7% 0.09G 5.3% 5.37G 22
WhNe Beer Laka............ 536 11.896 0.09L 4.79L 4.79L 25
Meplewood.................... 492 17.5% O.OX 4.3X 4.3K 21
Vednels Heights............. 20B 9.6% 0.09L 24% 2.4X 5
Artlen Hllls..................... 130 4.69G 0.09L 23% 239L 3
, Feloon FleipMs............... 149 5.49L 0.7% 0.7% 1.4% 2
Shorevlew...................... 3&5 7.89G 0.0% 1.37G 1.39L 5
Nonh oeks.................... 34 a0% 0.09L o.0% 0.0% 0
� ST.PAUL D/VIS/ON OF PUBLlC HEALTH
saacE w►...e.c.�.r a rwrw sa�:ra
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,
�
�
, 47
,.
� '
Maternal-Child Health Rey Data
�
LIVE BIRTHS TO TEENAGED MOTHERS
Ramsey County Residents, by Race, 1988 �
Percent teenage �
zs�
Zo% ._______________�.....wv ..._..� w..v.. .� �. �
,y � 3.
15 96 ,.,� .c �
••r•,
'•.,.. ;• ,:
....................... .... •LSY .... .... .... .... .... ,
lU 96 ... .. .. ... . . ... ...... .. .. ...
.�.;.
..� �
5% '�{:�• � !
i' �:
4 ( ,
�� v
White Black Indian Asian
Race . �
RESIDENT RAMSEY COUNTY LIVE BIRTHS IN 19�8 �
Total Taon moihar �
Race Live
Blrths Number Percent
Total........ 8276 731 8.890 �
Whlte........... 6559 421 6.49'0
Black............ 640 148 23.190
Indian........... 117 21 17.9�k
Asian............ 849 131 15.490 �
Other............ 111 10 9.090
Sou�cv: Ainn�aohC�nbrlorFN�lthSt�liafie� ,
,
. �
48 ,
,
,
INFANT MORTALITY RATES
� FOR SAINT PAUL RESIDENTS BY RACE,
IN THREE-YEAR RUNNING AVERAGES, 1980-1988
Infant deaths per 100011ve births
� as.o ;
3
r 30.0 ..... ..........�.... ............................... ..............-•-....................a..................
� B�e�k �
2a.o x...,,�,.�. ,,..... ,a. .,.,M.. .,��,,..,.ww.w�....,
i ......................................�..................
zo.o .................................................... ;
_
. �
�
� Total �
�s.o ................... all races ................................ .,.... ..........�..................
i
i
:
� �o.o :..,.....,......•...�..,....k,,.::.:. ...::N.w::.,..•.�•:,,.::.. ........:.3 ..
White
' .r.+. •
..... SEA/other• .......?..................
s.o .............................................. �
� �
o.o
�sso•es �9e�•sa »sz-s4 ��s�•as 1l�4-l6 �s�s-e� til6•tt
, Year of infant death
AVERAGE INFANT MORTALITY RATES BY RACE,
, ST.PAUL RESIDENTS, 1980-1988
IniaM d�afh�p�r t 000 ih�bf11h�
zs.o
21.9
� 20.0
� t s.o
f0.4 9.6
10.0 _...... ................_................»».... ........»...._..78..........
� 5.0
� 0.0
Total Wblt� Black •SE Asl��
�p��q� i oth�r
� ' TArSEAletMraWpayiP���^tlYSEAian.PwaorrdudvwMniaarrddnarMAi�raao�pfBYdurd
MrinnMarrra�Yow�ddrd R�wbrAm�rk�n Indl�nsMnat�AoM+rlw�inwNiir�unbus(amyl
il�dwlr a�rtlrwDyw�wboamdb ' widinb�rr�nn Duei4Mi�lm�prioaLllwhdint
. M�f�/NR�u�ln6rrlNrgi�Ylnn� bMrprdt7.0�br�dmt42iMrudutlr).rdtt.s
st�twrld�inAfnn�rar�SiondrthrbsnStP�Ir�Ik�yaW�mlrbtla�rinA(mwpoftiavoadd�ap�cl
llr SC P�IMW bvMrion Mdrr b ippe�in+w�/1rAfirr�olrwt�owrlmr.
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� 49
,
,
Maternal-Child Health Rey Data
. �
TREND IN INFANT DEATH RATES �
THREE-YEAR AVERAGES FOR RAMSEY COUNTY RESIDENTS,
1980-1988 �
Infant Deaths per 1000 Ilve births
�a.o • : �
� � �
�2.0 � �
i E j �
,�,�.a�..�.�.,,�.
Nuum,u i..�....._...._..�'�,1j„1,u����� ���� e Saint
10.0 ...._ _....._...._.E . ...!! n���.. ..._...___._... � ..P�ul ...... ....... ....__...._ �
� O�u� �
u�u�pum.��u�COYOtY s
3 � wid� a�u�nnianin�uw�inn�
8.0
i
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uburbs
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6.0
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25�:-Pwt?:;;f<: 10.4 }
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2.0 ' ' ................__.
. ._....__........................___..........._....�•_ _•-
oQ : iO : iQ.4 2id.E i � �
...............::{�:...............,............................... �
0.0 ' � ' ,
1980-82 1981-83 1982-84 1983-85 1984-86 1985-8� 1986-88
Three year pertod ' �
�
ANNUAL NUMBER AND RATE OF INFANT DEATHS, 1980-1988 �
Residencs TOTAL 1980 1981 1982 1983 1984 1585 1986 1987 1988 ,
Nw.s.r a iM.ne o..in.
RaTNy CauMy, LOn� 702 Td Q • 5� 7! 47 !e t1 7e
cn�r ee s.xn ww. ssa s3 n a 3e s3 �e s� e+ s3
e.nn.�r weursa =aa �o ts as u as p 3+ zo a ,
IM�M WfUIMy Iltl�
�.�.�r c.�mr, eeu� �.� +a2 �oz ».> >u as s.a �a.e �.s s.e
cn�r.t e.i�e r.w.__. �0.4 ».o i�s io.� a.> >as �w �zo as �0.3
�.� .uwr�.._� �.s aa �a n.� na �z sa s.s s.o sa �
. ST.PAU.DNISIONOF PLBLIC FEALlM �
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50 �
,
,
Maternal-Child Health Rey Data ,
, .
,
,
� 79-1988 '
ST. PAUL INFANT MORTALITY, 19
� [In 3-year moving averages]
Rate per 10001ive births
35.0
�
28.0
�
21.0 Black
,
� 14.0
•�-�- White
.
��� ���
, ` > �,. .�.
....
7�0 �' e���w �,.i�
Am.
Indian Asian/other
, 0.0
79-81 80-82 81-83 82-84 83-85 84-86 85-87 86-88
Year of infant death
i
�
�
�
�
, 51
,
,'.
Maternal-Child Health Rey Data
,.
�
TREND IN INFANT MORTALITY FOR SAINT PAUL RESIDENTS, 1966-1988
[Saint Paul's Infant Mortality Rate declined by 519'0(fiom 21.2 to 10.3),and the Neonatal Mortality Rate declined by 64qo �
(from 16.8 to 6.0)in the 22 yea:s since 1966. The number of live births to St.Paul residents decreased from 6,192 in 1966
to 5,126 in 1988--a 1790 drop. During the same period,live births classified as non-white increased from 49'o to 2990.)
Deaths per 1000 Live Blrths ,
zz.o
20.0 ..... .......�.••••..5.......... .:. ...�............ .. .. .. .. .. .. .. ....o.....,i.............4........... .. �
••'••...•••..�......:....... ......y......• ............�......... ...r........... ....�............ ....y...... ... . .. ..
18.0 • •. .. ...... ...E... . ...5.•-
16.0 .....................�...............E.......b...... . .. .. .. .. .. ....a......E.............a........... .. �
14.0 .......j......:•••••.........�••.....:............. `• .......... .. .. .. .. . .. .. .. .. .. ..
.
. . .
........ ...... .6-• ...... ..... ..+.. .........:... ..y... .
. . • . .
. , . . • .
. . . • .
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.
.
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.
1 Z.� ......�.."'.........fi....... ' j. .......�..... .. . .. ...q.......�.............y......t . ..
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. .......... ...
3 3 • ••�
10.0 - f -' " t "
...�. ..�.�-... ,
8.0 . ,. .
6.0 - _. . .. .. ... .... �
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2.0 _._.t.�.... - . _bw...,... . ....� ,
� y� ���
0.0 ` • . . • . . ,
ff 67 �S i9 70 71 72 73 7! 7S 7f 77 78 99 BO 81 82 a3 84 85 86 87 88
Year of Infant Death
�
sour,�: w�rn.ou aPr�m«,c a n.wn ,
SPDPH:LB(M�Y�001)
�
,
,
52 ,
,
� ;
Maternal—Child Health Rey Data
,
� DEATHS OF CHILDREN UNDER AGE 5 , B Y CAUSE
RAMSEY COUNTY RESIDENTS, 1988
� Cause of TOTAL Under Ages
Death <5 yrs age 1 1 to 4
, Number of deaths
Allcauses, total................................................... 86 73 13
' conditions ori inatin in crinatal, eriod (760-779)..:.::::;:.>:.:::::.»::::.:2b.:..;::.:::.,;::•>:;;:;:.>::;?b••»;;;;:,:;•>,r;;;.>.:;»:::,.�.
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::::::.:. ' 4
::.:::::::..::................... :...
Diseases of the respiratory system (460-519)............... 1 2
Pneumonia & influenza (480-487)....... ................. 3
Diseasea of the heart 8c circulatorx..s.Y.stem�(390-459)...:::::::::•:,:::::::::•:::.?•:::•:::::::::;::•..::::::.�;:::::::::.�:::::::::::::::".
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Diseases of che digestive system (520-579).................. 3 2 1
, Homicide (960-969)...................................................
Malignant neoplasms (140-208).................................. 2 - 2
Percentof deaths
� All causes, total................................................... 100.09'0 100.09'0 100.09'0
Certain conditions ori inatin in Perit►.acal,period.(760-779)..........:V.,.,30.290 35.69'0 0.090
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»::>:<:><::SuddC�i::«�fu11;�:::»d��ltl�F::::&'.l�.a..3................................ 7.090 5.59'c 15.490
Diseases of the respiratory system (460-519)...............
Pneumonia & influenza (480-487)......................... 3.59'0 1.496 15.49'0
Diseases of the heart & circulatory...system.::(390-459�....::.::.:.::.:::::::.:::.:2.3�Io:.::::::::::::::.:::::::::2.790.:::::::::::.:::..:0.090.
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�. .: '... v:i iiii ' .l�.Y.•i}i�i�4.��9.Y.�!l:4�.�1KH.�a.1f.;f�.H.;1.;f>YjR1.+,.�;R1i<1�4�,iiii:'riii:t.i'C::n:. .;•.•:w::n........:::: •. ::•
.il�`GCkt1v�.:::1�itt�...: #��.....................:.:::::::.::::..::...:::.::.::...:.::::::: . . :. Iy •............:::.�:• �. �.>:.::.>:.»;;:::r.>o-;::::>. '•
�...:;::::::::.�:::.�::..:::.::.:.i;.:::::::.::::::::::,::::::::.;:..:::. :..�:.:...:.:..:::::..:.::.:::.. . ..- •::::�:r<s:::::::;::;::::;:.�:.:::::::::::::::::::. .: �!
. ..�,.,,.....::•�.:::.. .:r �.•:.. .. . .,,;: . ,.; ..: ... ..:. . r+ 1:::•>sr>:•:i::%�::�:;:�!r ::?:•�:::::i:>:•;rr�'•:�i�:::$;::::::s>:r::;;�;�;�;y;I:'�„�,d;
D,se�as;:;�n�::<:c1�::::�at�cs�ts::::>4�!?5�#<:::�C::::?F�ttse.;;otg.��:<.��Q:<��..:w<:.:h:.::..:<:,,�.,::�.,,,�.>:::.:v:«..:v...:..........
, 2.390 1.49'0 7.790
Diseases of the digestive system (520 579). ..... .....
Homicide (960-969).... ........ ........ .... .... 3.59'0 2.79'0 7.79'0
......... .
Malignant neoplasms (140-208).................................. 2.39'0 0.096 15.4 0
, Prepared by Salnt Paul DNJsion ol Publlc Health, March 1991
, SOUACE OF DATA: Mnnesota Center Aor Healtl�Stadsdcs
,
,
, 53
,
�
Maternal-Child Health Ob7ectives/Methods/Bvaluation
,
Ramsey County Public Health Department
O OBJBCTIVS 1: TO INCRBASB ACCBSS TO NBBDBD SBRVICSS AND II�PROVS �
QUALITY AND CONTINUITY OF CARB BY FOSTBRING AND
ASSURING SSRVICB DBLIVBRY BFFICIBNCY, ,
COORDINATION OF SBRVICBS, AND OPSN LINES OF
COMMUNICATION WITHIN AND AI�IONG DISCIPLINSS.
(PROBLEMS 6-15) ,
Method la: Coordination of community partnerships that �
are designed to promote the health of Ramsey
County residents and strengthen families.
Evaluation la: Data are collected on partnerships developed, `
meetings held, and outcomes/system change;
analysis of data on full range of MCH ,
indicators.
Method lb: Provide Public Health ex ertise to �
P
development of care plans and interventions
for abused children in Ramsey County through �
PHN staffing of the Ramsey County Child Abuse
Team.
Evaluation lb: Information is collected on Child Abuse Team �
meetings, recommendations, and client
outcomes.
----- �
Method lc: Increase collaboration between PHNs and ,
Social Workers, and define roles with Child
Protection.
Evaluation lc: Information will be collected on ,
collaboration efforts and outcomes.
,
,
,
54 ,
,
�
Maternal-Child Health Obiectives/Methods/Evaluation
,
Method ld: Implement a planning team to include
� community clinics, other community providers
and advocacy groups, and Ramsey County
Community Human Services Department Childrens
Services staff to analyze and implement as
� appropriate a series of alternative service
delivery strategies which might include:
� 1. Advocating among Chemical Dependency
providers and the Southeast Asian community
for the development of opium treatment
services for the Southeast Asian community.
� 2. Developing a Paraprofessional Parent Aides
Program to work on Family Health teams to
� provide parenting education & support, etc.
3. Encouraging more adoption counseling in the
� community with pregnant and parenting teens;
exploring requiring this option as part of
contracts with providers that work with
teens; working with Adoption Option on public
, information campaign.
4. Seeking funding, in conjunction with school
, districts, for more Family Resource Centers
- piloting one in the suburbs (White Bear
Lake/Moundsview, Little Canada; West Side of
St. Paul) (check with St. Paul Schools re:
, additional 11 sites they previously
identif ied. )
� 5. Getting a mobile van to provide education,
immunizations, STD testing, family planning
onsite at Public Housing sites, homeless
, shelters, etc.
6. Meetinq with the Black community to develop
strategies to address high Black infant
, mortality rate; targeting hiring more Black
PHNs; developing Parent Aide Program,
tarqeting Black and SEA communities.
, 7. Working for consistency/coordination
throughout the MCH provider system;
� developinq a new MCH Community Consortium to
look at specific identified MCH problems and
develop community-wide intervention
strategies.
,
� 55
,
�
Maternal-Child Health Ob'iectives/Methods/Bvaluation
o OBJBCTIVB 2: BY DBCBMBBR 31, 1995, TO RBDUCS T9B INCIDBNCB OF
,
LOW BIRTHWSIGHT BIRTHS, SBXUALLY TRANSI�IITTBD �
DISBASBS, AND LATB OR NO PRBNATAL CARB BY 5$ FROM
1988 FIGURBS, AND TO DBCREASB THB INCIDENCB OF
BIRTHS TO 1�1DOLBSCBNTS BY 10$ FROM 1988 FIGURBS.
(PROBLSMS 8, 9, 11, 12) �
Method 2a: Provision of nursing assessment, skilled �
nursing care, case management/service
coordination, education on proper prenatal
care, prevention of childhood injury, and �
prevention of subsequent unintended
pregnancies.
Evaluation 2a: Data are collected on numbers of clients ,
served, units and types of services provided,
and service outcomes. Thirty thousand home
visits annually provided to parents and �
children who are at high risk for abuse and
neglect. Eight thousand home visits are
provided annually to high risk antepartum/ ,
postpartum clients. During 1990, 1,001
individuals received 7,280 parenting home
visits, 141 women under age 19 received ,
antepartum home visits, 249 women under age
19 received parenting home visits, 99 women
under age 19 received post partum home
visits, and 207 women under age 19 received ,
high risk maternal health home visits.
Visits cited above include services to 1,500
incoming refugees per year to assess health �
needs and establish a plan to reduce and
prevent health problems.
----- ,
Method 2b: Provision of accurate Maternal-Child Public
Health information to health, education, and ,
social service professionals who can address
MCH issues in their work with clients.
Evaluation 2b: Data are collected on number and content of ,
consultations and classes provided. Five
hundred health consultations and classes to �
1,500 individuals at various facilities are
provided annually.
----- ,
56 �
� _ ���3
9i
�
Maternal-Child Health Ob'iectives/1Kethods/Svaluation
�
, Method 2c: Provision of health education regarding
prevention of unintended teen pregnancy,
sexually transmitted disease, the need for
, early prenatal care, and parenting skills to
Suburban Ramsey County residents.
, Evaluation 2c: Data are collected on nwabers and types of
educational sessions provided and number of
individuals attending. One hundred seventy-
five group health education sessions are
, provided to 1,500 Suburban Ramsey County
residents annually.
, -----
Method 2d: Improve quality and consistency of services
, by implementing Family Health guidelines and
assuring they are carried out by all Family
Health PHNs.
, Evaluation 2d: Information is collected documenting the
implementation of Family Health quidelines.
, -----
, o OBJECTIVE 3: TO PROPIDB NEBDBD SBRVICBS TO MAINTAIN
CBRONICALLY ILL CHILDREN IN THSIR HOI�S,
ASSURING SBRVICBS TO 100$ OF APPROPRIATI3
REFERRALS BASED ON AVAILABLB FUNDING.
, (PROBLSI�I 13�
, Method 3a: Extended hours in-home health services are
assured to individuals who need extended
hours nursing care.
, Evaluation 3a: Data are collected on nwaber of clients
served and services provided.
, -----
�
,
, 57
,
�
Maternal-Child Health Ob7ectives/Methods/Bvaluation
�
Method 3b: Provision of nursing assessment, skilled ,
nursing care, case management/service
coordination, education on proper prenatal
care, prevention of childhood injury, and ,
prevention of subsequent unwanted
pregnancies.
Evaluation 3b: Data are collected on numbers of clients ,
served, units and types of services provided,
and service outcomes. During 1990, 44
children with birth anomalies received 342 ,
home visits, 44 persons with metabolic
disorders received 585 home visits, and 23
persons suffering from various injuries ,
received 477 home visits.
Method 3c: Screenin for eli ibilit to the followin ,
9 9 Y 9
waivered service programs: Community
. Alternatives for Disabled Individuals (CADI) , ,
Community Alternatives for Care (CAC) , and
Children's Home Care Option CHCO -- (formerly
TEFRA) ; development and monitoring of care ,
plans funded through these proqrams.
Evaluation 3c: Data are maintained on eligible clients,
screenings, services arranged for and ,
delivered, and outcomes of care. Two
thousand clients are projected to be served
annually. (Fiqure includes elderly clients. ) ,
Method 3d: Provision of nursing assessment, skilled ,
nursing care, case management/service
coordination, and education for children with
respiratory problems. ,
Evaluation 3d: Data are collected on numbers of clients
served, units and types of services provided, ,
and service outcomes. Eleven children below
age 19 with respiratory problems received 337
home visits in 1990. �
,
58 ,
,
,
Maternal-Child Health Ob�ectives/Methods/Bvaluation
�
, Method 3e: Training of Family Health staff on
recognizing children at risk or with
developmental delays; development of
, inservices between Department staff & ECFE
staff to share expertise & increase knowledge
base; encourage RCCHSD involvement in 0-5
, Program.
Evaluation 3e: Information will be collected on training and
inservice efforts and interactions with
� RCCHSD.
� o OBJECTIVS 4: TO ASSIST 100$ OF FAMILIBS WHO HAVB BXPBRIBNCSD A
SIDS DBATH.
, (PROBLSM 14)
� Method 4a: Provision of in-home support and grief
counseling to families and day care providers
who have experienced a SIDS death.
, Evaluation 4a: Data are collected on nwnbers of clients
served, units and types of services provided,
and service outcomes. Eleven parents and day
, care providers of SIDS children received 37
home visits in 1990.
, -----
, o OBJECTIVE 5: TO REDUCB RAI�ISBY COUNTY CHILDRBN'S BXPOSURB TO
HBALTH RISRS IN DAY CARB CBNTBRS AND HOI�S AND TO
MONITOR AND ASSURB SBRVICBS AS NBCBSSARY TO
ADDR$SS BLSVATED LSAD LBVSLS IN SUBURBAN RAI�ISEY
� COUNTY CHILDRBN.
(PROBLSM 7)
, -----
Method 5a: Day Care:
� a. Monthly day care consultation to 20
infant/toddler/preschool centers which
focus on injury prevention, food safety,
childhood immunizations, communicable
, disease prevention, etc.
, 59
,
,
Maternal-Child Health Ob�ectives/Methods/Bvaluation
b. Quarterly in-services to Family Day Care �
Licensing staff and on-going telephone
consultation to licensers and family day ,
care providers re: child safety,
immunization status, communicable disease
prevention,etc.
Evaluation 5a: Data are collected on consultations. ,
Approximately 240 onsite day care
consultations and 1,000 telephone ,
consultations were provided during 1990.
Method 5b: Lead Pro ram: �
9
Educational materials and medical follow-up
are provided as indicated to clients with ,
elevated ZEP levels and/or elevated direct
blood lead levels.
Evaluation 5b: Data are collected on persons identified with ,
elevated ZEPS and elevated direct lead levels
in Suburban Ramsey County. Approximately 75
clients were followed for elevated ZEP levels �
and 0 for elevated direct lead levels in
1990.
----- ,
o OBJSCTIVE 6: TO ASSURB THB PROVISION OF HIGH QUALITY, LOW
COST, ACCBSSIBLB FAMILY PLANNING SBRVICBS TO LOW ,
INCOMB, UNINSURED AND UNDBRINSURED RAMSBY COUNTY
WOMBN AND TBSNS, AS WSLL AS COMI�IUNITIBS OF COLOR.
. ,
Method 6a. The Department will coordinate with community
Family Planning providers on 1992-93 Family ,
Planning Special Projects Grant applications
specific to Ramsey County, and will apply for
funds to provide/purchase services if gaps in
service areas and target populations are not �
addressed by community providers' _
applications.
Evaluation 6a: Service data from funded Family Planning ,
Special Projects agencies in Ramsey County
for 1992-93 will address all identified ,
service areas and target populations.
(NOTE: Also see Goals, Objectives and Methods contained in Ramsey
County Formula Maternal and Child Health Special Projects ,
Grant. )
60 ,
,
�
Maternal-Child Health Ob7ectives/Methods/Bvaluation
�
Ramsey County Public Health Department/St. Paul Division of Public
Health
,
o OBJSCTIVB l: TO ASSURB THB PROVISION OF HIGH QUALITY,
, ACCBSSIBLB CLINIC-BASSD MATBRNAL-CHILD BBALTH
CARB ON A SLIDING FBB SCALS TO ALL IAW-INCOMB
UNINSURBD AND UND$RINSURBD RAMSBY COUNTY
� RBSIDBNTS.
(PROBLSMS 6, 8, 9, 10, 11, 12, 13, 14, 15)
� Method la: Funding is provided to seven Community
Clinics (Face to Face Health and Counseling
Center, The Family Tree, Health Start,
� United Family Practice/Helping Hand Health
Center, Model Cities Health Center, North End
Health Center, and West Side Community Aealth
� Center) to subsidize the cost of primary and
preventive health care services, including
medical, dental, family planning, and general
and tarqeted health education on a sliding
, fee scale to low income, under- and uninsured
Ramsey County residents.
� Evaluation la: Data are collected on numbers of clients and
services provided as well as financial
status. An estimated total of 117,870 visits
� were provided to 56,920 patients in 1990.
(City and County funding covers only a
portion of the total costs for this level of
service. )
�
(NOTE: Also see Objectives and Methods in Nutrition Section. )
�
�
�
,
�
, 61
,
Maternal-Child Health ObjectivesfMethodsfEvaluation �
St. Paul Division of Public Health �
• OBJECTIVE 1: TO IMPROVE PREGNANCY OUTCOMES FOR ST. PAiJL WOMEN,
DECREASING INFANT MORTALITY TO 8.9� AND LOA BIRTH ,
AEIGHT RATES TO 4$ BY DECEMBER 31, 1995.
(PROBLEMS 6, 8, 11, 12)
---- ,
Method la: Funding to the City of St. Paul through the
Minnesota Department of Health Maternal and Child �
Health Special Project Grant is subcontracted to
Health Start, Inc . , and other various agencies for
two year periods to undertake MCH activities . �
Evaluation la: Data is collected to indicate the number of
women served and the type of service received �
through the use of these funds .
Additionally, data indicating infant
mortality and low birth weights are reviewed
to identify trends over time and target ,
areas .
---- ,
Method lb: Staff from the SPDPH participate as active members
of the City' s Infant Mortality Task Force, �
identifying related issues and causes, and
recommending action and programs to address infant
mortality.
�
Evaluation lb: Evaluation of the activity of this group will �
be based on recommendations which are made
and activities which will be undertaken.
---- �
Method lc: A new budget/activity code entitled "Infant
Mortality" has been proposed to be included in the �
SPDPH 1992 budget. If approved, additional
activities will be identified to further address
infant mortality issues . �
Evaluation lc: Evaluation will be identified at a later
date, pending formulation of actual
objectives and methods related to this �
activity.
---- �
62 ,
,
, Maternal-Child Health ObjectivesfMethods/Evaluation
, • OBJECTIVE 2: DECREASE BY 5$ THE NUMBER OF INJURIES AND REPORTED
ILLNESSES OF THE USERS OF ST. PAIIL'S LICENSBD
FACILITIES (INCLUDING DAY CARE CENTERS, SDPERVISED
ROOMING AND BOARDING FACILITIES, SWIMMING POOLS
, AND RESTAURANTS) BY DECEMBER 31, 1995.
(PROBLEM 7)
� ----
Method 2a: Inspection of licensed day care facilities and
education of staff ensure that children are placed
� at minimal risk while in this setting. Efforts
are focused on injury prevention, immunization
sufficiency, food safety, and communicable disease
� control. Telephone consultation/information is
also provided.
, Evaluation 2a: Reports of day care injuries requiring
medical attention and illness are reported to
the DPH and monitored. Centers with
increased rates are targeted for further
� education and inspection.
, Method 2b: Public swimming pools are inspected, and water is
analyzed to assess water quality and ensure
� safety.
Evaluation 2b: Data are collected on the results of
inspections and water tests, and appropriate
, action is ordered when problems are
identified.
, Method 2c: Establishment ins ection and education is
P
� completed to stress prevention and to reduce
likeliness of foodborne illness, responds to and
investigates complaints . Approximately 9,000
inspections performed in 1990.
* Evaluation 2c: Establishments are given correctional orders
for any problems and expected to resolve
� these problems in order to continue
operation. Inspectors receive training and
information to ensure consistency and
completeness of inspections . Approximately
, 9,000 inspections performed in 1990.
�
, 63
,
Maternal-Child Health Objectives/Methods/Evaluation ,
Method 2d: Beginning late summer of 1991, a mandatory program ,
required by St. Paul ordinance, will provide food
manager training courses to further educate food
managers on the proper manners of handling food
and utensils, and maintaining their establishments ,
to ensure safe food preparation.
Evaluation 2d: Individuals passing the food managers �
training course will be certified.
Recertification is required every two years.
---- �
Method 2e: Licensed supervised rooming and boarding
facilities are inspected at least once per year �
for health and safety hazards. Telephone
consultation/information is also provided.
Evaluation 2e: Data on the number of orders issued and . ,
abated indicates the number of hazards noted
and corrected.
---- �
� OBJECTIVE 3: TO ASSURE THE PROVISION OF HIGH QUALITY, LOW COST, �
ACCESSIBLE REPRODUCTIVE HEALTH SERVICES TO
LOA INCOME, UNINSURED AND UNDERINSURED ST. PAUL
RESIDENTS. (PROBLEM 9) �
Method 3a: The St. Paul Division of Public Health provides a �
full range of family planning services at two
locations (the Public Health Center, and the North
Suburban Youth Services in the New �
Brighton/Moundsview area) .
Evaluation 3a: Data are collected to identify numbers of
clients served and visits made each year. �
Client satisfaction surveys are performed
annually to identify areas needing
improvement. �
Method 3b: Early pregnancy diagnosis is available on a walk- �
in basis at the Division of Public Health.
Evaluation 3b: Data are collected indicating the number of �
individuals receiving pregnancy testing and
counseling.
�
64 ,
,
, Maternal-Child Health Objectives/MethodsfEvaluation
, Method 3c: Funding to the City of St. Paul through the
Minnesota Department of Health Maternal and Child
Health Special Project Grant is subcontracted to
three agencies (Health Start, Inc. , Model Cities
� Health Center and Face to Face Health and
Counseling Center) to support efforts to provide
outreach, transportation, education and prenatal
� care to high risk, low income women.
Evaluation 3c: Data is collected to indicate the number of
� women served and the type of service received
through the use of these funds.
Additionally, data indicating infant
mortality and low birth weights are reviewed
� to identify trends over time and target
areas .
� ----
• OBJECTIVE 4: TO DECREASB BY 5$, FROM THE 1990 RATE OF 47
CHILDRI3N AITH A BLOOD LEAD LEVEL GREATER THAN OR
, EQUAL TO 25 MCG�DL BY DECEMBER 31, 1995. (NOTE:
CDC AILL BE ISSUING NEW GIIIDELINES IN LATE 1991
FOR DEFINING AND SCREENING FOR LSAD POISONING.
, TAIS MAY INCREASE THE NUMBER OF CASES IDENTIFIED
DDRING THE NEBT FEW YEARS. )
(PROBLEM 7)
, ----
Method 4a: High risk children who are seen in the WIC clinics
, are screened for possible lead poisoning through
micro blood lead testing.
� Evaluation 4a: Children whose tests reveal abnormal blood
lead levels are either seen in followup at
the Division of Public Health, or are
� referred to another health care provider of
their choice for followup. Data indicating
lead poisoning incidence in St. Paul is
monitored, and services targeted accordingly.
� ----
� Method 4b: Will continue to evaluate the feasibility of
additional screening sites in high risk areas
throughout the community.
� Evaluation 4b: High risk areas will be identified, and the
DPH will work with other agencies to
determine how to best provide the screening
� services .
� 65
,
Maternal-Child Health ObjectivesfMethodsfEvaluation ,
Method 4c: Environmental surveys are performed on dwellings ,
where children identified with high lead levels
live. Paint samples are collected from various
locations in the dwelling and analyzed for lead
content. Based on the results of the �
environmental surveys, orders are written to
correct existing hazardous conditions .
Evaluation 4c: Data are collected to identify number of �
samples taken, as well as response time for
evaluation and correction of unhealthy �
conditions.
Method 4d: Lobb in efforts are made to rovide funding with �
Y g P
any legislative mandates that address screening,
evaluation and abatement of lead hazards so that �
programs have sufficient funding to be
comprehensive and fully address the issues.
Evaluation 4d: Efforts are evaluated based on appropriation �
of funds to manage the mandates .
---- ,
Method 4e: Various assistance, consultation and coordination
of services provided by private physicians is �
performed by DPH staff. DPH staff provide
technical information, patient education,
environmental evaluations and patient monitoring
of patients seen by private physicians . ,
Evaluation 4e: Effectiveness is evaluated by monitoring and �
comparing the time it takes for the blood
lead level to decrease to below toxic levels
as defined by CDC.
---- �
Method 4f: Education regarding lead hazards and poisoning is �
provided to clients and community groups through
presentations, videos and printed information.
Various materials are available in non-English �
languages and are provided to other agencies and
organizations .
Evaluation 4f: Data are collected indicating the number of �
individuals receiving education through one-on-one
education and community presentations . �
66 ,
,
� Maternal Child Health ObjectivesfMethods/Evaluation
, • OBJECTIVE 5: TO INCREASE ACCESSIBILITY TO HEALTH SERVICES BY
ADOLESCENTS, AND DECREASE THE RATE OF
TEEN PREGNANCY BY 2$ AND SE%UALLY TRANSMITTED
DISEASE BY 2$, COMPARED TO 198$ DATA, THIZODGH
� 1995.
(PROBLEMS 8 AND 9)
� ----
Method 5a: Funding is provided to support school based
clinics managed by Health Start through both City
� general funds, and City of St. Paul MCH funds
received from the Minnesota Department of Health.
� Evaluation 5a: Data are collected on the number of students
utilizing school based clinic services, and
on the type of service utilized.
� ----
Method 5b: A full range of family planning and sexually
� transmitted disease prevention services and
information are available to adolescents through
the St. Paul Division of Public Health Family
� Planning, Room 111, and Health Education programs .
Evaluation 5b: Data are collected on the number of
individuals provided with service, and the
� type of service provided. Additionally,
disease and pregnancy rate data are also
reviewed to identify target populations .
,
(NOTE: For additional information on St. Paul Division of
' Public Health activities related to maternal and child
health, see the St. paul Division of Public Health Maternal
and Child Health Special Project Grant Proposal)
�
�
�
,
�
, 67
,
,
Maternal-Child Health Inventory
o Prenatal/Delivery/Postpartum/Pediatric Services �
o Bethesda Family Practice Clinic, 559 Capitol Blvd. , St. Paul �
o Face to Face Health and Counseling, 642 E. 7th Street, St. Paul
o Health Care for the Homeless Project, 153 Concord, St. Paul
o Seton Center, 57 West lOth Street, St. Paul
o MOD Clinic, United Hospital, 333 North Smith Street, St. Paul �
o Family Physician's Health Center, 579 Wells Street, St. Paul
o West Side Community Health Center, 153 Concord Street, St. Paul
o Model Cities Health Center, 430 N. Dale Street, St. Paul �
o North End Health Center, 135 Manitoba Street, St. Paul; 2900 Rice
Street, Little Canada
o Health Start, 640 Jackson Street, St. Paul
o St. Paul-Ramsey OB/GYN Clinic, 640 Jackson Street, St. Paul �
o Children's Hospital, 345 North Smith Avenue, St. Paul
o Group Health, Inc. : 2500 Como Avenue, 205 S. Wabasha, St. Paul;
2165 White Bear Avenue, Maplewood; 1430 Hwy 96, White Bear Lake �
o Medica Health Plan, 1006 Rice Street, 1020 West Bandana Blvd. , St.
Paul
o St. John's Northeast Hospital, 1575 Beam Avenue, Maplewood �
o United Family Practice/Helping Hand Health Center, 545 West 7th
Street, St. Paul
o Commonhealth Clinic, 13961 North 60th Street, Stillwater
,
o Family Planning Providers � Referral Agencies
o Children's Home Society, 2230 Como Avenue, St. Paul i
o Commonhealth Clinic, 13961 North 60th Street, Stillwater
o Face to Face Health and Counseling, 642 E. 7th Street, St. Paul
o Family Tree, 1619 Dayton Avenue, St. Paul �
o Group Health Teen Clinic, 2500 Como Ave. , St. Paul
o Health Start, 640 Jackson Street, St. Paul
o Hearing Impaired Health and Wellness Services, 640 Jackson, St. �
Paul
o The Loft, 1063 Iglehart, St. Paul
o MOD Clinic, United Hospital, 333 North Smith Street, St. Paul �
o Model Cities Health Center, 430 N. Dale Street, St. Paul
o North End Health Center, 135 Manitoba Street, St. Paul; 2900 Rice
Street, Little Canada
o Northwest Teen Health Center, 1775 Old Hiqhway 8, New Brighton �
o Peer Education Health Resources, 1600 Portland Avenue, St Paul
o Planned Parenthood of Minnesota, 1965 Ford Parkway, 1700 Rice
Street, St. Paul �
o St. Paul-Ramsey OB/GYN Clinic, 640 Jackson Street, St. Paul
o United Family Practice/Helping Hand Health Center, 545 West 7th
Street, St. Paul �
o West Side Community Health Center, 153 Concord Street, St. Paul
�
68 �
r
�
Maternal-Child Health Inventorv
,
o Referral Sources for Hiqh Risk Infants
, o Children's Hospital, 345 N. Smith Avenue, St. Paul
o Gillette Children's Hospital, 200 University Avenue, St. Paul
o Model Cities Health Center, 430 N. Dale, St. Paul
� o St. Paul-Ramsey Medical Center, 640 Jackson Street, St. Paul
o SPRC, Inc. 709 University Avenue West, St. Paul
� o Suburban Ramsey County Pediatric Providers
o Maplewood Clinic, 1774 Cope Ave. E. , Maplewood
o Pediatric & Adolescent Medicine, 3615 Grand Ave. , White Bear Lake
� o Pediatric and Younq Adult Clinic, 1655 Beam Ave. , Maplewood
o Pediatricians for Health, 1655 Beam Ave. , Maplewood
� o Suburban Ramsey County Family Practice Providers
o Maplewood Clinic, 1774 Cope Ave. E. , Maplewood
, o Minn Health - Maplewood, 1814 North St. Paul Road, Maplewood
o Minn Health - White Bear, 3220 Bellaire Ave. , White Bear Lake
o Marianto Chau, 1010 Hwy. 96, White Bear Lake
o Roseville Family and Industrial Clinic, 2215 Snelling Ave,
, Roseville
o Rosedale Medical Center, 2467 N. Fairview, Roseville
o Shoreview Family Physicians, 3200 Lexington Ave. , Shoreview
� o Northeast Community Physicians Group, 1655 Beam Avenue, Maplewood
o North St. Paul Medical Center, 2579 7th Ave. E. , North St. Paul
o Parkview Family Care Centers, 1560 Beam Ave. , Maplewood*
, o G.W. Schossow, 2448 E. Co. Rd. F, White Bear Lake**
o A.J. Rushay, 2023 E. Cty. Rd. E. , White Bear Lake**
o William Roberts, 2184 4th Street, White Bear Lake
� o Suburban Ramsey County OB/GYN Providers
o Parkview OB/GYN P.A. , 1560 Beam Ave. , Maplewood**
� o Metropolitan Obstetrics & GYN, 1655 Beam Ave. , Maplewood**
o Charles Crutchfield, 2555 E. Cty. Rd. E. , White Bear Lake; 4625
Churchill, Shoreview***
� o Northeast Obstetrics & Gynecology, 1010 E. 8wy. 96, White Bear
Lake**
o Charles Schaffhausen, 2555 E. Cty. Rd. E. , White Bear Lake**
o Twin City OB/GYN LTD, 2015 Rice Street, Roseville**
� o Tolomeo Onq, 4625 Churchill Street, Shoreview**
, * Will accept M.A. patients, but prefer not to
** Will not accept M.A. patients
*** Accepts M.A. patients if referred by another physician
�
, 69
r
�
Maternal-Child Health Inventory
�
o Bducational Resources
o Early Childhood Intervention Services, 360 Colborne, St. Paul ,
o Early Childhood Family Education, Early Childhood Special
Education, and Preschool Screening in the following Districts:
-St. Paul School District #625, 360 Colborne, St Paul �
-Moundsview School District #621, 2959 Hamline Ave. , Moundsview
-Roseville Area School District #623, 1251 W Co Rd B2, Roseville
-North St. Paul-Maplewood-Oakdale Area School District # 622, �
2055 Larpenteur Av E, Maplewood
-White Bear Lake Area School District #624, 2399 Cedar, White Bear
Lake �
o Ramsey County Early Intervention Alliance, 1910 West County Rd. B,
Roseville
o Ramsey County Libraries
o RAP Headstart, St. Paul �
o Resources for Child Caring, St. Paul
o St. Paul Libraries
o Support Services t
o Childbirth Education Association of Greater Mpls/St. Paul
o Clues, 220 S Robert St, St. Paul �
o Crisis Nurseries, Children's Home Society, St. Paul
o Family Resource Centers: Payne-Phalen, Frogtown
o Family Services, St. Paul �
o Family to Family Ties, 373 Selby, St. Paul
o Health Care for the Homeless Project, 153 Concord, St. Paul
o Institute on Black Chemical Abuse, 217 Mackubin, St. Paul
o March of Dimes �
o MELD and MELD Special, 123 No. 3rd St. , Mpls
o Minnesota Sudden Infant Death Center, 2525 Chicago Ave. ,
Minneapolis �
o Northwest Youth and Family Services, New Brighton
o Pacer (Parent Advocacy Coalition for Education Rights)
o Parent Outreach Project, St. Paul Area Council of Churches '
o Pathfinder Resources, Inc. , St. Paul
o Pilot Parents, ARC Ramsey County, 425 Etna St. #35, St. Paul
o St. Paul Youth Service Bureau
o YES/NEON �
o Additional Private 1rICH Medical Providers
o Alexander Abrams MD, 491 University Ave. , St. Paul �
o Afton Road Clinic (Johnson Clinic) , 2716 Upper Afton Road,
Maplewood �
o Arcade Medical Clinic, 651 Arcade Street, St. Paul
o Associated Medical Clinic, 2381 Rice Street, Roseville
o Bethesda University Family Practice, 590 Park Street, St. Paul
o Central Internal Medicine Associates, 570 Asbury Street, St. Paul �
70 �
,
�
Maternal-Child Health Inventory
�
o Additional Private 1�ICH Medical Providers (cont. )
to Central Pediatrics, Central Medical Building, St. Paul
o Como Park Physicians, 801 Front Ave. , St. Paul
o East Side Medical Center, 891 White Bear Avenue, St. Paul
� o JoAnn Fasching, R.N. (in-home EPSDT screeninq) , 1947 W. 9th St, WBL
o Hazel Park Family Practice Center, 933 White Bear Ave. , St. Paul
o Arnold Joseph, M.D. , 1586 University Ave. , St. Paul
� o Midway Family Physicians, 1690 University Avenue, St. Paul
o Robert P. Nelson, M.D. , 1301 Payne Avenue, St. Paul
o North Suburban Family Physicians, 404 West Hiqhway 96, Shoreview
o Enrique Ospina, M.D. , 1260 W. Co. Road E, Arden Hills
� o Parkway Family Clinic, 721 Snelling Ave. S. , St. Paul
o Payne Avenue Medical Association, 1239 Payne Ave. , St. Paul
o Pediatric & Adolescent Medicine, 3615 Grand Ave. , White Bear Lake
� o St. Paul Children's Hospital Clinic
� In addition to acceptinq Medical Assistance, the Community Clinics
(Face to Face, Family Tree, Health Start, Helping Hand, Model Cities,
North End, and West Side) MOD Clinic, And Seton Center offer low cost
medical care with a sliding fee scale available based upon income and
, family size. Appointments are generally available for prenatal and/or
family planning services within two weeks.
�
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� 71
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�
Bnvironmental Health/Solid waste Problems/Goals
�
PROBLSIrI 16: Prevalence of qroundwater, surface water, soil, and air
� pollution **
GOAL 16: To assure safe, clean air and water and to reduce risks
associated with exposures to hazardous substances for
� all residents of Ramsey County
� PROBLEM 17: Lead-based paints: ingestion by children, improper
removal and disposal, incidence of lead poisoning cases
in Ramsey County children
� GOAL 17: To eliminate exposure of Ramsey County children to lead
and to assure proper removal and disposal
� -----
� PROBLEM 18: Occurrence of bacteria, viruses, pesticides, and
chemicals in food resulting in illness and/or toxic
exposures
� GOAL 18: To assure a food supply free of harmful bacteria,
viruses, pesticides, and chemicals for all Ramsey County
residents
� -----
PROBLEM 19: Occurrence of exposure to second-hand smoke in public
� facilities due in part to lack of awareness/enforcement
of the Minnesota Clean Indoor Air Act
� GOAL 19: To eliminate exposure to second-hand smoke in public
facilities and to assure awareness/enforcement of the
Minnesota Clean Indoor Air Act
� -----
PROBLEM 20: Higher than average radon concentrations in Ramsey County
� homes
GOAL 20: To eliminate harmful residential radon exposures for all
� Ramsey County residents
� ** Identified as one of thirteen Highest Priority Problems by St.
Paul-Ramsey County Community Health Services Advisory Committee
�
� 72
�
�
Environmental Health/Solid Waste Problems/Goals
�
PROBLEM 21: Occurrence of sick building syndrome
GOAL 21: To assure safe building environments relative to air �
quality, heating, cooling, lighting, etc. for all persons
working in Ramsey County
----- �
PROBLEM 22: Workers at risk from improper disposal of household �
hazardous waste, infectious wastes, illegal drug labs,
explosives/ammunitions, etc. ; garbage haulers and Solid
Waste facility operators �
GOAL 22: To assure worker safety among waste haulers and solid
waste facility operators �
PROBLEM 23: instances of improper disposal of household and �
industrial hazardous waste
GOAL 23: To eliminate improper disposal of household and �
industrial hazardous waste
----- �
PROBLEM 24: Increasing amount of unsafe and poor quality housing
GOAL 24 : To eliminate threats to personal health caused by unsafe �
and poor quality housing
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73 �
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�
Bnvironmental Health/Solid Waste Rey Data
,
1. In 1989, 260 routine inspections were completed of the 1, 100
identified/licensed hazardous waste generators in Ramsey County,
� and 300 new generators were identified, inspected and licensed.
2. In 1989, 217 residential wells and non-community water supplies
� were sampled and the water tested. Private water supplies were
tested, and 81 homes near the Lake Jane landfill were sampled and
tested; significant work was done toward the development of a new
� water supply for these Washington County residents.
3. Recycling Service Data:
Population served: All single family dwellings in Ramsey County; a
� portion of multifamily dwellings in Ramsey County; and a portion
of Commercial/Industrial/Institutional (C/I/I) waste generators
Units of Service: Curbside collection to SFD at least twice
� monthly for at least four materials; technical assistance to
municipalities and C/I/I generators
Annual Data: 1989 residential tons collected: 16,053;
� 1989 Commercial/Industrial tons collected: 58,591.
1990 residential tons collected: 28,358
Commercial/Industrial tons collected: 91,052
� 4 . Yard Waste Service Data:
1990 site visits to yard waste sites: 293,783
1990 cubic yards delivered to yard waste sites: 77,512
� 1990 tons delivered to yard waste sites: 28,669
5. Household Hazardous Waste Service Data:
In 1989, 185 tons of household hazardous and related waste were
� collected and properly disposed of; in 1990 over 1,700 calls were
received from residents regarding household hazardous waste and
problem waste.
� 6. Solid Waste Public Education Service Data:
1990 Telephone Calls (633-EASY) : 33,083 (March - December)
� Direct Mail Brochures: Yard Waste - 155,000; General SW - 155,000
Turf Manaqement Flyer: 50,000 (Handed out at yard waste sites)
School Folder Distribution: 75,000
Newspaper Advertisements: Yard Waste (3j , Barth Day, Recycling -
� 155,000 each in major and community newspapers
7. Solid Waste Regulation Service Data:
� Collector/Transporters licensed: 76; Transfer stations licensed:
6; Waste Processing Facilities: 1
� 8. In 1989, there were 58 lead poisoning cases in St. Paul, and in
1990, there were 47 cases. In Suburban Ramsey County,
approximately 75 clients were followed for elevated ZEP levels and
0 for elevated direct lead levels in 1990.
�
� 74
�
�
Bnvironmental Health/Solid Waste Rey Data
�
9. In 1990 in St. Paul, there were increased numbers of lead cases
among Whites, American Indians and Hispanics, and decreased �
nwnbers of cases among Blacks and Hmong persons.
10. Nationally, 80+� of the population eats away from the home on a
regular basis, averaging 3.5 times per week, resulting in ,
increased potential for foodborne disease outbreaks.
11. In 1989, 540 inspections were made of the 399 Suburban Ramsey �
County food establishments. There were 93 food complaints
received and 39 were investigated through inspection. Inspections
were made of 137 temporary food facilities and 50 institutions.
12. A total of 17 Suburban Ramsey County lodqing facilities were �
inspected twice each during 1989.
13. There were 70 complaints and 39 inspections of public health �
nuisances in Suburban Ramsey County conducted in 1989.
14. According to a 1991 Report commissioned by the Federal �
Environmental Protection Agency, second-hand tobacco smoke kills
53,000 non smokers annually in the United States, with 37,000 of
these deaths from heart disease. The Report identifies �
second-hand smoke as the third leadinq cause of death, behind
smoking and alcohol.
15. A World Health Organization Committee has estimated that up to 30$ �
of new and remodeled buildings have "sick buildinq syndrome", i.e.
its occupants complain of health and comfort problems related to
being in/working in the building. �
16. There is more hazardous waste generated per square mile in Ramsey
County than in any other County in Minnesota. On average, over �
100 tons of hazardous waste per square mile is generated each year
in the County.
17. The graphics on the following two pages illustrate the volume and �
results of actions taken on vacant buildings in the City of St.
Paul and inspection scores of St. Paul restaurants in 1990.
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75 �
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�
Bnvironmental Health/Solid Waste Rey Data
'
� ACTION TAKEN O N VACANT
BUILDINGS in 1990
Of 760 buildings monitored in St. Paul
� �..;,, ����:`.s�".�� „
�.'�'•:`:'r'' ,,' �: { �A • �
•:<3'' ,E: �:;�:. '••..
':�, t:?''s'
r�`r'•• 275 �''
� �;:���� ' �;: ,
. •.
.<;:: .• ,
.• w . ..
:,;,.:
r>�. •:. •
f�.• ,� • ,;�{�• •,... .�... .:«. :�:>:: f
„;.;�:��y'.j 'Y$' ':'{' �t�`•�
.�, �
�::,��, t•�. 5 0
� }
..�'?`�:,k; 2 5
4
�
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� � Re-occupied
Demolished by owner
� Demolished by Clty
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� Ly11�L Percent
Totai vacant buildings......... 760 100%
� Monitored only .............. 410 54%
Condition abated.............. 350 46%
� Re-occupied................. 275 36%
Demolished by owner... 25 3%
Demolished by city....... 50 7%
�
St Pau/Division o/Public Health
Judy Ban: July 1991
�
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� 76
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Environmental Health/Solid Waste Rey Data
. �
INSPECTION SCORES �
of St. Paul Restaurants in 1990
�
65%
�
<•,��,,{;
• 6%
:::::�»
t::•,�4`:::::,`v,:ji:�+�ii?ii}::::.....
i+�
::w,.,.
..w
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�<.;:o...
���4
:t2 0>':::�'<�:`::?::>`:z�;;;
/
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❑ 90-100 � 70-79 � 0-59 �
Q 80-89 60-69
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Inspections �
Score �im� Percent
90-100............................... 1,277 65.2% �
80-89................................. 475 24.3%
70-79................................. 125 6.4%
• 60-69................................. � 2.8%
0-59................................... 27 1.4% �
Total............................ 1,958 100.0%
' Scores below 70 are failing and require an administrative �
hearing and possible closure of the restaurant.
St Paul Divislon o/Public Health �
lB: ,�uy ts9t
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Environmental Health/Solid Waste Obiectives/Methods/Bvaluation
�
Ramsev Countv Public Health Department
� o OBJBCTIVB 1: TO BNSURB PROPBR HANDLING AND DISPOSAL OF
HAZARDOUS WASTB GBNBRATBD BY 100$ OF IDBNTIFIBD
, INDUSTRIAL HAZARDOUS WASTB GBNBRATORS IN RAMSBY
COUNTY. TARGBT POPULATIONS ARB HAZARDOIIS WASTE
GBNERATORS, AND ALL COUNTY RBSIDBNTS WHO COULD
� B$ ADVSRSBLY AFFBCTED BY IMPROPSR HANDLING AND
DISPOSAL OF HAZARDOUS WAST$.
(PROBLSMS 16, 22, 23)
� -----
Method la: Licensing, inspection, monitoring, and
� regulation of 100� of identified industrial
hazardous waste qenerators in Ramsey County.
� Evaluation la: Data are kept on all identified hazardous
waste generators, including types and volumes
of waste generated, means and sites of
disposal, etc via the federal manifest
� system.
, Method lb: Investigation of 100$ of hazardous waste
complaints, and enforcement of Federal,
State, and County hazardous waste rules and
� requlations.
Evaluation lb: Data are kept on all complaints received,
� investigations resultinq, and any corrective
actions required.
� TIVS 2: PROVISION OF INFORMATION ON PROPBR MANAG81rIBNT OF
o OBJEC
PROBLEr[ WASTES, INCLUDING HOUSBHOLD HAZARDOUS
� WASTBS, AND OPPORTUNITIBS FOR PROPLR MANAGBMBNT
TO 100$ OF RAMSBY COUNTY RBSIDBNTS.
(PROBLBMS 16, 22, 23)
� -----
Method 2a: Provision of information to the public on the
� proper management of problem waste, including
household hazardous waste, and collection/
processing as needed.
�
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�
$nvironmental Health/Solid Waste Ob7ectives/Methods/Bvaluation
. �
Evaluation 2a: Data are collected on types, volume and
impact of information to the public on the �
proper management of problem waste, and
volumes and types of problem wastes,
including household hazardous waste
collected_and processed appropriately. ,
o OBJECTIVS 3: TO IDSNTIFY AND REDUCB GROUNDWATBR POLLUTION �
WHICH MIGHT ADVSRSELY AFFSCT DRINRING WATER AND
HUMAN H8ALT8 IN 100$ OF T� RBSIDBNTIAL WSLLS
AND NON-COI�II�IUNITY WATBR SUPPLIBS IN SUBURHAN
RAMSBY COUNTY. TARGBT POPULATIONS ARS RAMSBY �
COUNTY RESIDENTS AND BUSINBSSBS WITH PRIVATB
WSLLS, AND WASHINGTON COUNTY RBSIDBNTS ADVSRSBLY
IMPACT$D BY SW-1 (LARB JANS LANDFILL) . �
(INVESTIGATION AND ABATBMENT OF ABANDONBD WELLS
REQUIRED IN MN STATUTBS 145A.04. )
(PROBLF�li 16) �
Method 3a: Sampling and testing of water on request at �
residential wells. Routine sampling of non-
community water supplies.
Evaluation 3a: Data are collected on testing kits requested, �
test results, and corrective measures
recommended/required/taken.
----- �
Method 3b: Sampling and testing of water at 81 homes �
near the Lake Jane landfill was completed;
significant work has been done toward the
development of a new water supply for these �
Washington County residents.
Evaluation 3b: Complete records are maintained on ground-
water pollution at SW-1 and all corrective �
actions studied and taken.
----- �
o OBJECTIVE 4: TO BNSURB APPROPRIATB MANAGBMSNT OF RECYCLABLE
IrIATERIALS AND YARD WASTB. TARGET POPULATION IS �
ALL SOLID WASTB GBNBRATORS IN RAMSBY COUNTY.
(PROBLSMS 16, 22, 23)
�
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Environmental Health/Solid Waste Obiectives/Methods/Bvaluation
� -----
Method 4a: County coordinates with municipalities for
� residential curbside collection and drop-off
centers; processing and marketing of
collected recyclable materials and yard waste
, is completed at County-owned recycling
facility and yard waste sites; technical
assistance is provided to municipalities and
� commercial/industrial/institutional waste
generators; public information is provided on
recycling for residents and for the
commercial/industrial/institutional sector.
� -----
� Evaluation 4a: Data collected volume by type of recyclable
materials and yard waste collected through
residential curbside collection and drop-off
centers; processing and marketing of
� collected recyclable materials and yard waste
at County-owned recycling facility and yard
waste sites; amount, type and outcomes
� of technical assistance provided to
municipalities and commercial/industrial/
institutional waste generators; and amount,
� types and impact of public information
provided on recycling and yard waste
manaqement for residents and for the
commercial/industrial/institutional sector.
� o OBJECTIVB 5: TO R1;GULATB SOLID WASTB SBRVICBS IN RAMSBY
COUNTY IN ORDBR TO SIGNIFICANTLY RBDUCB IMPROPBR
, MANAGBIYIBNT OF WASTB AT UNLICBNSBD FACILITIBS,
ASSURS DSLIVSRY OF WASTB TO DBSIGNATBD FACILITY,
(NSWPORT RDF PLANT) , PROTBCT AGAINST FURTHBR
� GROONDWATBR POLLUTION AND OCCURRRNCB OF PUBLIC
N[JISANCBS DUS TO IMPROPBR OPBRATION OF VSHICLBS
AND FACILITIBS, AND TO PROMOTS CONSBRVATION OF
BNERGY AND MATBRIALS. TARGBT POPULATIONS ARB
� MUNICIPAL SOLID WASTE COLLBCTORS AND
TRANSPORTBRS, SOLID WASTB FACILITY OWNSRS AND
OPBRATORS, AND ILLSGAL DUlrIPBRS (SBRVICB/
� RSGULATION PROGRAM) ; AND RAMSBY COUNTY
RESIDBNTS, AND BUSINSSSBS OPBRATING IN RAMSBY
COUNTY (PROTBCTION PROGRAl�I. )
� (PROBLSMS 16, 22, 23)
�
, 80
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�
Bnvironmental Health/Solid Waste Ob7ectives/Methods/Svaluation
----- �
Method 5a: Licensing of and consultation with solid
waste collectors, transporters and �
facilities; routine inspection to determine
compliance with County ordinances and State
rules; investiqation of complaints and �
enforcement as necessary.
Evaluation 5a: Data collected on licensin of and �
9
consultation with solid waste collectors,
transporters and facilities; routine �
compliance inspections; and investigations
of complaints and enforcement actions.
o OBJBCTIVE 6: TO REDUCB THE POTBNTIAL FOR FOODBORNB DISEASB �
FROM UNSAFB AND UNSANITARY FOOD BSTABLISffi�ISNTS
AT 100$ OF SUBURBAN RAMSBY COUNTY FOOD
BSTABLISffi�1SNTS. �
(PROBLBK 18)
----- �
Method 6a: Licensing, inspections, enforcement, testing,
and education proqrams for food establish- �
ments to prevent/reduce the occurrence of
foodborne illness. Target populations are
food establishments, and the population which
uses them. �
Evaluation 6a: Data are collected on inspections made at
Suburban Ramsey County food establishments, �
food complaints received, complaints
investiqated through inspection, inspections
made of temporary food facilities and �
institutions, and corrective actions
required, including criminal prosecutions of
violators.
----- �
o OBJECTIVB 7: TO BLIMINATB THB POTBNTIAL SPRBAD OF DISBASB �
CAUSED BY VIOLATION OF TH$ MINNBSOTA CLBAN
INDOOR AIR ACT IN 100$ OF AFFBCTED BUSINBSSBS IN �
SUBURBAN RAMSBY COUNTY.
(PROBI.SI�IS 19, 21)
�
81 !
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�
Bnvironmental Health/Solid Waste Obiectives/l�Iethods/Bvaluation
� -----
Method 7a: Investigation and abatement of complaints
� regarding the MCIAA in Suburban Ramsey
County. Target populations are Suburban
Ramsey County residents and persons using
, Suburban Ramsey County facilities which come
under the jurisdiction of the MCIAA.
� Evaluation 7a: Data are collected on complaints received,
investigated, and outcomes of investigations.
(Note: As of 6/91, the County only
investigates complaints involving Ramsey
� County licensed establishments. Al1 other
complaints are referred to the Minnesota
Department of Health. )
� -----
� o OBJECTIVS 8: TO IDBNTIFY AND ASSURB CORRSCTION OF
BNVIRONPIBNTAL CONDITIONS IN 100$ OF LODGING
FACILITIBS IN SUBURBAN RAMSSY COUNTY THAT IrIIGHT
ADVBRSBLY AFFBCT HUMAN HSALTH AND SAFBTY.
� (PROBLSM 24)
� Method 8a: Continuous surveillance and enforcement of
all laws and regulations pertaining to
lodging facilities in Suburban Ramsey County
� to maintain a high level of compliance.
Target populations are Suburban Ramsey County
lodging facilities, and people that use them.
� Evaluation 8a: Data are kept ensurinq that all Suburban
Ramsey County lodqing facilities are
� inspected twice annually, including
inspection scores and required corrective
measures.
, -----
, o OBJSCTIVE 9: TO BLIMINATB THS POTBNTIAL SPREAD OF DISBASB AND
OCCURRSNCB OF ACCIDBNTS CAUSSD BY PUBLIC HSALTH
NUISANCSS IN 100$ OF PRIVATB RESID$NCBS IN
� SUBURBAN RAI�ISBY COUNTY. (RBQUIRBD IN MN STATUTES
145A.04. )
(PROBI.SMS 17, 2 4)
�
I82
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�
Bnvironmental Health/Solid Waste Ob7ectives/Methods/Bvaluation
�
Method 9a: Investigation and abatement of complaints �
regarding public health nuisances, i.e.
vector and vermin, trash houses, and sewage
and water in Suburban Ramsey County. Target ,
populations are Suburban Ramsey County
residents potentially or actually adversely
impacted by public health nuisances. �
Evaluation 9a: Data are collected on complaints received,
investigated, and outcomes of investigations.
----- �
o OBJSCTIVS 10: TO BLIMINATB BXPOSURBS OF CHILDREN AND PRBGNANT �
WOI�N TO RSSPIRABLS AND/OR INGSSTIBLS TOXIC
LEAD. (RBQUIRED IN l�T STATUTBS 4761.01. ) �
Method 10a: Identify housing structures with ingestible
or respirable lead sources and screen target
populations for elevated lead levels. ,
Evaluation 10a: Data will be collected on survey of housing
structures, identified sources of lead, and �
screening results among target populations.
(NOTE 1: Also see description of Lead Program under Maternal-Child �
Health Section, Method 6b) (Problem 17 )
(NOTE 2: Specific Solid Waste Goals with quantified abatement �
objectives can be found in the Ramsey County Solid Waste
Master Plan. )
�
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83 ,
�
, Environmental Health/Solid Waste ObjectivesfMethodsfEvaluation
� St. Paul Division of Public Health
• OBJECTIVE 1: TO DECREASE, FROM 1990 LEVELS, THE NUMBER OF
� IINSAFE AND IINHEALTSY HOUSING CONDITIONS BY 5$
IN ST. PAUL THItODGH IDENTIFICATION AND CORRECTION
BY DECEMBER 31, 1995.
, (PROBLEM 24)
� Method la: Investigations are made in response to interior
and exterior housing code violation complaints to
help ensure safe and healthy housing in St. Paul.
, Targeted neighborhood enforcement is completed
also. Ordinances are enforced and legal action
may be taken.
� Evaluation la: Response and correction of unsafe and
unhealthy conditions is monitored and
evaluated through repeat complaints and
� ensuring that corrections are made.
� Method lb: Complaints regarding unoccupied buildings which
may pose a health or safety hazard are
� investigated. Buildings may be secured, and
repair or wrecking of buildings may be ordered.
Evaluation lb: Status of vacant buildings is monitored to
, ensure appropriate measures are taken in a
timely manner to eliminate health and safety
hazards.
� ----
Method lc: The Truth In Sale of Housing program is a
, preventions/awareness program to ensure the
housing being transferred from one party to
another is safe and poses no health risks .
, Evaluation lc: Data are collected on the number and status
of reports filed. This program is
� administered by the City, however inspections
are completed by private evaluators.
� ----
�
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Environmental HealthfSolid Aaste ObjectivesjMethods,(Evaluation ,
Method ld: Information and referrals to other various �
community resources are made to clients and
persons inquiring about housing issues which the
St. Paul Division of Public Health does not deal
directly with. �
Evaluation ld: Information and referral resource lists are
updated to ensure accurate referrals are ,
made. Data could be collected to indicate
the number of referrals made to other
community resources. �
• OBJECTIVE 2: TO ELIMINATE FOODBORNE ILLNESS DQE TO UNHEALTHY �
FOOD PREPARATION AND STORAGE IN 100$ OF ST. PADL
ESTABLISHMENTS.
(PROBLEMS 18 AND 19) �
Method 2a: Establishment inspections are made which focus on �
prevention and provide education to reduce
likeliness of foodborne illness; responds to and
investigates complaints. �
Evaluation 2a: Establishments are given correctional orders
for any problems and expected to resolve �
these problems in order to continue
operation. Inspectors receive training and
information to ensure consistency and
completeness of inspections. Approximately ,
9,000 inspections were performed in 1990 .
Method 2b: Be innin late summer of 1991 a mandato ro ram �
9 9 , rY P g
required by St. Paul ordinance, will provide food �
manager training courses to further educate food
managers on the proper manners of handling food
and utensils, and maintaining their establishments
to ensure safe food preparation. ,
Evaluation 2b: Individuals passing the food managers
training course will be certified. �
Recertification is required every two years .
Method 2c: Licensed da care facilities in St. Paul are �
Y
inspected to ensure safe food storage and
preparation. �
85 ,
,
� Environmental HealthfSolid Waste Oblectives/MethodsfSvaluation
, Evaluation 2c: Data are collected on the number of
facilities inspected, and on orders issued
and corrective action taken.
� ----
Method 2d: Itinerants and mobile food units must apply for a
� license before operating, and are inspected to
ensure safe food storage and preparation.
� Evaluation 2d: Data is collected regarding inspections and
orders issued.
� • OBJECTIVE 3: BY DECEMBER 31, 1995, DECREASE BY 5$ THE 1�iU1KBER
OF BLOOD LEAD POISONING CASES OF ST. PAIIL CHILDREN
� FROM 47 IN 1990. (NOTE: CDC WILL BE ISSIIING NEW
GUIDELINES IN LATE 1991 FOR DEFINING AND SCREENING
FOR LEAD POISONING. THIS MAY INCREASS THE NUMBER
OF CASES IDENTIFIED DiJRING THE NE%T FEW YEARS. )
� (PROBLEM 17)
� Method 3a: Environmental surveys are performed on dwellings
where children live who have been identified to
� have high blood lead levels . Paint samples are
collected from various locations in the dwelling
and analyzed for lead content. Based on the
results of the environmental surveys, orders are
, written to correct existing hazardous conditions.
Failure to correct hazardous conditions may result
in a citation, orders for condemnation of the
� dwelling, or both.
Evaluation 3a: Data are collected to identify number of
, samples taken, the numbers of samples
identified as containing more 0.5$ lead, the
number of orders written, as well as response
time for correction of hazardous conditions .
, ----
� Method 3b: Consultation with property owners is provided by
Division staff on proper lead abatement methods .
� Evaluation 3b: Proper abatement is evaluated.
�
� 86
�
Environmental HealthfSolid Waste ObjectivesfMethodsfEvaluation �
• OBJECTIVE 4: TO CONTINUE TO DECREASE AND ELIMINATE A VARIETY OF ,
ENVIRONMENTAL SITOATIONS WHICH MAY BE HARMFIIL TO
THE ST. PAUL COMMUNITY.
(PROBLEMS 16, 19, 20 AND 21) �
Method 4a: By St. Paul ordinance to be established in Fall �
1991 individual septic systems will need to be
registered and inspected annually. Compliance
with the ordinance will be enforced. �
Evaluation 4a: Reports of systems and ratings will be
collected and reviewed.
�
Method 4b: Will plan to develop a registration system for St.
Paul water wells, similar to the septic system ,
evaluations and inspections, requiring annual
testing of water from the wells . Corrective
actions may be ordered.
Evaluation 4b: Data will be collected on the testing and �
evaluation of the water wells.
---- �
Method 4c: According to St. Paul ordinance, complaints of ,
excessive noise are responded to and investigated.
Orders may be issued to reduce or eliminate the
noise source.
Evaluation 4c: Data are collected on the complaints made and ,
the orders issued.
---- �
Method 4d: As part of the food inspection program, food �
establishments are monitored for compliance with
the Minnesota Clean Indoor Air Act. Complaints
are investigated.
Evaluation 4d: Orders are issued for corrective actions �
which need to be made.
---- �
Method 4e: Continue to cooperate with Ramsey County in the
investigation of hazardous waste complaints, and ,
to ensure the proper disposal of household and
industrial hazardous waste within St. Paul.
�
87 �
� /- /g�3
�
� Environmental Health�Solid Waste ObjectivesfMethods/Evaluation
� Evaluation 4e: Status of complaints and correction of
harmful situations will be monitored.
� ethod 4f: Investi ation of com laints regarding Sick
M 9 P
Building Syndrome is completed, and
, recommendations are made regarding corrective
measures . Referrals to other agencies for further
investigation are also made.
� Evaluation 4f: Data are collected on investigations made,
findings identified and referrals made.
� ----
Method 4g: Currently investigate air pollution complaints and
� issue orders to eliminate problems, or refer to
the Minnesota Pollution Control agency for further
action.
� Evaluation 4g: Data are collected on investigations made,
findings identified and referrals made.
� ----
Method 4h: Printed educational materials regarding
environmental issues are available to the public
� upon request or through presentations. Various
materials are developed in non-English languages .
� Evaluation 4h: Information provided in materials is reviewed
for accuracy and updated as necessary.
� ----
Method 4i: Information and referrals to other various
community resources are made to clients and
� persons inquiring about environmental health
issues which the St. Paul Division of Public
Health does not deal directly with.
, Evaluation 4i: Information and referral resource lists are
updated to ensure accurate referrals are
, made. Data could be collected to indicate
the number of referrals made to other
community resources .
,
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�
�
Environmental Health/Solid Waste Inventorv
�
RECYCLING AND YARD WASTE PROGRAMS BY MUNICIPALITY - RAMSBY COUNTY
ARDBN HILLS �
PROGRAM OPERATED BY FUNDED BY *
Yard Waste Site Ramsey County Ramsey County �
Curbside Recycling Program Arden Hills Ramsey County
E-Z Recycling �
FALCON HEIGHTS
PROGRAM OPERATED BY FUNDED BY �
Curbside Recycling Program Falcon Heights 1990 Ramsey County
Knutson 1991 - Local funding
GBM LARE �
PROGRAM OPERATED BY FUNDED BY
Curbside Recycling Program Gem Lake Ramsey County ,
Wynne's Rubbish
LAUDERDALB �
PROGRAM OPERATED BY FUNDED BY
Curbside Recycling Program Lauderdale Ramsey County �
Supercycle
Household Donation Center Goodwill Goodwill
LITTLE CANADA �
PROGRAM OPERATED BY FUNDED BY
Curbside Recycling Program Little Canada 1990 - Ramsey County �
Haulers in City 1991 - Local funding
MAPLEWOOD i
PROGRAM OPERATED BY FUNDED BY
Yard Waste Site Ramsey County Ramsey County ,
Curbside Recycling Program Maplewood Ramsey County
Gopher Recycling �
NOTB ,
* Local funding means that the primary source of funding is from City
funds or direct charges to residents through utility bills or hauler
bills. The local mechanism varies from City to City.
�
89 ,
�
�
Bnvironmental Health/Solid Waste Inventory
�
MOUNDS VIEW
� PROGRAM OPERATED BY FUNDED BY
Yard Waste Site Ramsey County Ramsey County
, Curbside Recycling Program Mounds View 1990 - Ramsey County
Haulers in City 1991 - Local funding
� NEW BRIGHTON
PROGRAM OPERATED BY FUNDBD BY
� Curbside Recycling Program New Brighton Ramsey County
E-Z Recycling
� NORTH OAKS
PROGRAM OPERATED BY FUNDED BY
� Curbside Recycling Proqram North Oaks Local funding
Jim Peterson
NORTH ST. PAUL
� PROGRAM OPERATED BY FUNDED BY
Curbside Recycling Program No. St. Paul Ramsey County
� TMT Recycling
ROSEVILLB
PROGRAM OPERATED BY FUNDED BY
rYard Waste Site (leaves only) Roseville Roseville
Curbside Yard Waste Program Roseville Roseville
, (leaves only)
Curbside Recycling Program Roseville Ramsey County
� Supercycle
� ST. ANTHONY
PROGRAM OPERATED BY FUNDED BY
Curbside Recycling Program St. Anthony Local funding
Haulers in City
� Dropoff Recycling Center St. Anthony Local Funding
�
,
r90
�
�
Bnvironmental Health/Solid Waste Inventory
�
ST. PAUL
PROGRAM OPERATED BY FUNDED BY �
Yard Waste Sites
District 1 Ramsey County Ramsey County
District 5 Ramsey County Ramsey County
District 11 Ramsey County Ramsey County �
District 16 Ramsey County Ramsey County
Yard Waste Site Concordia Coll. Concordia Coll. �
Yard Waste Site CWI Inc. CWI, Inc.
Yard Waste Site Haul-A-Way,Inc. Haul-A-Way, Inc. �
Recycling Processing Fac. Recomp, Inc. Ramsey County
Greenwing Drop Off Supercycle Supercycle �
Curbside Recycling Program NEC Ramsey County �
District 14
Supercycle
Gopher Recycling
E-Z Recycling �
Transfer Station Haul-A-Way, Inc.
Transfer Station Twin City Refuse �
Transfer Station Twin City Sanitation
Transfer Station Keith Krupenny �
Transfer Station Disposal Systems ,
Processing Facilty Cleansoils, Inc.
SHOREVIEW ,
PROGRAM OPERATED BY FUNDED BY
Curbside Recycling Program Shoreview Ramsey County �
Supercycle
�
VADNAIS HEIGHTS
PROGRAM OPERATED BY FUNDED BY ,
Curbside Recycling Program Vadnais Heights 1990 - Ramsey County
Vadnais Heights 1991 - Local Funding
�
91 ,
�
�
Bnvironmental Health/Solid Waste Inventory
�
WHITB BEAR LARB
PROGRAM OPERATED BY FUNDED BY
� Curbside Recycling Program Wh. Br. Lake Local funding
Knutson San.
� WHITB B$AR TOWNSHIP
PROGRAM OPERATED BY FUNDED BY
� Curbside Recycling Progaram Wh. Br. Twp. Local funding
Lake Sanitation
� Yard Waste Site Ramsey County Ramsey County
, NOTB:
There are nwaerous outlets for major appliances, automotive batteries,
� used motor oil, tires, scrap metal and recyclable items throughout the
County. The Ramsey County Recycling and Disposal Guide (April 1989) is
the most comprehensive source availble at this time.
� In addition, most cities in the County have solid waste ordinances
that regulate waste haulers, open dumping and waste handling. We are
in the process of collecting copies of these ordinances for our
� planning process. Some cities also have ordinances that regulate
scavenging of recyclables, organize waste collection, mandate services
etc.
� BNVIRONMSNTAL HEALTH SBRVICB PROVIDBR/ADVOCACY ORGANIZATIONS
, o Hospital Institute of Technoloqy & Management, 830 Transfer Road,
St. Paul
o Minnesota Food Association, 2395 University Avenue, St. Paul
� o Minnesota Grocers Association, 533 St. Clair Avenue, St. Paul
o Minnesota Hotel and Motor Hotel Association, 871 Jefferson, St.
Paul
o Minnesota Restaurant Association, 871 Jefferson, St. Paul
, o Neighborhood Energy Consortium, 2429 University Avenue, St. Paul
o Resources for Child Carinq, Inc. , 450 Syndicate, St. Paul
o St. Paul Food Bank, 1140 Gervais Avenue, Maplewood
� o St. Paul Housing Information Office, 21 W. 4th Street, St. Paul
o St. Paul Housing Agency, 350 Gilbert Bldg. , 413 Wacouta, St. Paul
o St. Paul Tenants Union, 500 Laurel Avenue, St. Paul
,
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� � • •
�
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,
�
Mental Health/Chemical Dependencv Problems/Goals
, -----
PROBLEM 25: Increasing numbers of inentally ill individuals living in
� the community who need assistance in medication
manaqement and daily livinq tasks **
� GOAL 25: To assure assistance in medication management and daily
living tasks for mentally ill individuals living in the
community
, -----
PROBLEM 26: Prevalence of chronic illness/impairment in children and
� adults associated with Fetal Alcohol Syndrome and other
drug abuse, increasing prevalence of drug-attached
newborns and cocaine babies
' GOAL 26: To eliminate the incidence of chronic illness/impairment
in children and adults associated with fetal alcohol
� syndrome and other drug abuse, and drug-attached newborns
and cocaine babies
, PROBLEM 27: Prevalence of chronic illness/disabilities associated
with alcohol, other chemical and IV druq abuse
� GOAL 27t To reduce to a minimum the incidence of alcohol, other
chemical and IV drug abuse and to assure services to
address chronic illness and disabilities associated with
� abuse of these chemicals
� PROBLEM 28: Increasing prevalence of chronic illness/disabilities
associated with smoking/tobacco use in teens
� GOAL 28: To eliminate smoking/tobacco use in teens and to assure
services to address chronic illness/disabilities
associated with these practices
� -----
,
** Identified as one of thirteen Highest Priority Problems by St.
� Paul-Ramsey County Community Health Services Advisory Committee
�
, 93
,
,
Mental Health/Chemical Dependency Problems/Goals
�
PROBLEM 29: Increasing prevalence of psychiatric and chemical �
dependency problems in non-English speaking populations
GOAL 29: To reduce the incidence of psychiatric and chemical �
dependency problems in non-English speaking populations,
and to assure cultural- and language-appropriate services
to these populations �
PROBLEM 30: Increasing prevalence of automobile driving under the �
influence of alcohol and various chemicals
GOAL 30: To eliminate automobile driving under the influence of ,
alcohol and various chemicals
PROBLEM 31: Mental health roblems and chemical abuse/de endence �
P p
among the elderly
GOAL 31: To reduce the incidence of inental health problems and �
chemical abuse/dependence among the elderly and to assure
appropriate services to address these problems in this �
population
�
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94 ,
i
�
Mental Health/Chemical Devendency Rey Data
, 1. Fetal Alcohol S ndrome is estimated to occur nationall in 1-3 of
Y Y
every 1,000 live births. The consequences are irreversible and
� may include mental retardation, heart problems, and a lifetime of
special needs. FAS is one of the top three causes of birth
defects, and is the only one that is preventable.
, 2. According to the Drug Abuse Prevention Resource Council, in 1989
Ramsey County reported 15 cases per month of women delivering
� infants who were chemically addicted.
3. St. Paul-Ramsey Medical Center estimates from 1-3 infants born
per week are affected by cocaine and other illicit drugs.
� 4 . In local surveys conducted by private HMOs and hospitals, as many
as 11� of randomly selected pregnant women have tested positive
, for cocaine and other illicit chemicals.
5. Ramsey County Human Services currently averages 10 high risk
and/or cocaine baby referrals at Intake per month.
� 6. In 1988, 23. 1$ of all Ramsey County adults were estimated by MDH
to be at risk for acute alcohol consumption and 6.7� were at risk
, for chronic drinking.
7. In 1987, in Ramsey County there were a total of 44 deaths caused
� by cirrhosis of the liver.
8. In 1988, 6. 1$ of adults in Ramsey County were estimated by MDH to
be at risk for drinking and driving, compared to a statewide rate
, of 5.9$.
9. According to the Minnesota Prevention Resource Center, in 1986,
� 49$ of fatally injured drivers were intoxicated at the time of
their fatal accidents. Ninety-three percent of all drivers who
died in automobile accidents between 9:00 p.m. and midnight had
� been drinking.
10. The Minnesota Office of the American Automobile Association
reports that alcohol is involved in approximately 50� of all
, highway deaths.
�
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i
�
Mental Health/Chemical Dependency Objectives/Methods/Bvaluation
Ramse Count Public Health De rtment ,
v y na
o OBJSCTIVS l: TO PROVIDB HOME VISITING SBRVICB INCLIIDING CASB �
MANAGffi�ISNT/SBRVICB COORDINATION AND MBDICATION
ADMINISTRATION AND IrIANAGBIYIBNT TO 100$ OF
APPROPRIATB RSFBRRALS RBCBIVSD. ,
(PROBI�SKS 25, 29, 31)
Method la: Nursin assessment skilled nursin care and ,
9 . 9 .
case management/service coordination for
mentally ill individuals living in the �
community who need assistance in daily living
tasks.
Evaluation la: Data are collected on number of inentally ill ,
individuals served, services provided, and
outcomes/impact of services. During 1990, a
total of 298 mentally ill individuals �
received 3,825 home visits to maintain or
improve health status.
----- ,
o OBJBCTIVS 2: TO INCREASB ACCBSS TO NSBDBD I�NTAL HBALTH AND �
CBBMICAL DBPBNDBNCY SBRVICBS AND IIKPROVB
QUALITY AND CONTINUITY OF CARB BY FOSTBRING AND
ASSURING SBRVICS DBLIVBRY BFFICIBNCY,
COORDINATION OF SBRVICBS, AND OPBN LINBS OF �
COMliUNICATION i�IITHIN AND AMONG DISCIPLINES.
(PROBLSMS 25-31)
----- �
Method 2a: Coordination of community partnerships that ,
are designed to promote the health of Ramsey
County residents and strenqthen families.
Evaluation 2a: Data are collected on partnerships developed, ,
meetinqs held, and outcomes/system change;
analysis of data on full range of inental
health and chemical dependency indicators. �
Method 2b: Work with the Ramsey County Mental Health �
Planning Team to develop community-based
Crisis Intervention Team and Ramsey County
Mental Health Center Injection Clinic. �
96 ,
,
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Mental Health/Chemical Dependency Ob)ectives/Methods/Bvaluation
�
Evaluation 2b: Information will be collected on the outcomes
of these planning and implementation efforts.
� -----
� Method 2c: Provide PHN consultation with Ramsey County
Mental Health Intake staff and assessment
visits with Social Workers for Vulnerable
� Adults, Chemical Dependency referrals,
elderly, & young adults in need of direct
services and information & referral.
� Evaluation 2c: Information is collected on consultations,
co-visits, and referrals.
, -----
Method 2d: Provide Public Health expertise to
, development of care plans and services for
mentally ill and chemically dependent persons
in Ramsey County through PHN staffing of the
Ramsey County Mental Health and Chemical
, Dependency Planning Teams.
Evaluation 2d: Information is collected on Planning Team
, meetinqs & outcomes/recommendations.
� Method 2e: Provide Public Health expertise to
development of care plans and interventions
for drug-abusing parents and their children
� in Ramsey County through PHN staffing of
Ramsey County Maternal-Child Project and the
Health Start CARES Program.
, Evaluation 2e: Client outcomes and outreach efforts are
thoroughly documented in each program.
, -----
Method 2f: Implement a planning team to include
� community clinics, high rise and Public
Housing staff, and Ramsey County Community
Human Services Department Mental Health and
, Chemical Dependency staff to analyze and
implement as appropriate a series of
alternative service delivery strategies which
might include:
�
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�
�
Mental Health/Chemical Dependency Ob7ectives/Methods/Bvaluation
1. Develo ment of su ortive services in Public �
P PP
Housing sites, including: triaging,
referral; classes on various health topics; �
teaching residents how to live with
increasing numbers of MI/MR residents;
developing a system to case manage & support �
increasing MI population in high rises; and
setting up regular planning meetings with
Public Housing staff to develop strategies/ �
programs.
2. Combining screening with education at high
rises (for elderly as well as mentally ill �
and chemically dependent persons) , i.e.
providing colon cancer education along with
rectal screenings, BP screening along with ,
focused education on nutrition, where to get
screening on a regular basis, etc.
3. Addressing fragmentation in system by: �
increasing Public Health Department staff�s
education re: available resources; exploring
teaming PHNs with Mental Health Intake, ,
teaming on case management and assessment
(Pre Admission Screening model) ; ensuring
ongoing contact with Social Workers, not only ,
at times of crisis; and joint staffings on
the chronically mentally ill to identify ways
to prevent new problems, including
development of community care plans. �
Evaluation 2f: Information will be collected on planning,
implementation and outcomes of alternative �
strategies.
Method 2 : Advocate for a smooth transition of Mental ,
9
Health and Chemical Dependency into the
Prepaid Medical Assistance Program in Ramsey ,
County.
Evaluation 2g: The Ramsey County Community Auman Services �
Department and the Minnesota Department of
Human Services will devote extensive efforts
to evaluating PMAP. ,
�
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Mental Health/Chemical Dependency Oblectives/1rlethods/Evaluation
,
� Method 2h: Enhance linkages with schools through
Community Health & Health Education on
tobacco use and drug use prevention efforts.
� Evaluation 2h: Infonaation will be collected on joint
planning efforts and service outcomes.
, -----
o OBJBCTIVE 3: BY DBCBMBBR 31, 1995, TO REDUCS TBE INCIDENCB OF
� CHBMICAL AND DRUG ABUSB IN RAKSBY COUNTY
RESIDBNTS, INCLUDING: A RBDUCTION IN THE N[II�BR
OF DRUG-AFFECTBD INFANTS BORN IN RAMS$Y COUNTY; A
� RBDUCTION IN DRUG-RBLATBD AUTOMOBILS ACCIDBNTS IN
RAI�SBY COUNTY; AND A RSDUCTION IN DRUG-RBLATSD
CRIMES IN RAMSBY COUNTY.
� -----
Method 3a: The Department will initiate the development
, of community-wide partnerships with
business, civic groups and other community
resources to foster the development of
, chemical health promotion activities, and
will apply for grant funding as appropriate
to implement these activities.
� Evaluation 3a: Outcomes of the planning, implementation,
and outcomes of chemical health promotion
strategies which result from this process
, will be documented.
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�
�
Mental Health/Chemical Dependencv Ob7ectives/l�iethods/Evaluation
St. Paul Division of Public Health/Ramsey County Public Health ,
- Department
o OBJECTIVS l: TO ASSURB TH8 PROVISION OF HIGH QUALITY, �
ACCBSSIBLS CLINIC-BASBD I�BNTAL HEALTH CARB ON A
SLIDING F8B SCALE TO ALL IAW-INCOIrIS UNINSURBD AND �
UNDBRINSURED RAMSBY COUNTY RBSIDBNTS.
(PROBLBMS 25-31)
Method la: Fundin is rovided to two Communit Clinics ,
9 P Y
(Face to Face Health and Counseling Center
and North End Health Center) that provide �
mental health services to low income, under-
and uninsured Ramsey County residents.
Evaluation la: Data are collected on numbers of clients and �
services provided as well as financial
status. (City and County funding covers only �
a portion of the total costs for this level
of service. )
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�oo �
,
, Mental HealthfChemical Dependency ObjectivesfMethodsfEvaluation
, St. Paul Division of Public Health
• OBJECTIVE 1: TO INCREASE AWARENESS OF THE HARMFUL EFFECTS OF
, CHEMICAL ABIISE, INCLiTDING INHAI�ANTS, ALCOHOL AND
OTHER SUBSTANCES, AND REDUCE ABUSE OF THESE
SUBSTANCES THItOUGH 1995.
, (PROBLEMS 26, 27, 30 AND 31)
, Method la: Health Education promotes chemical-free living
through the development and distribution of
brochures, programs (Project H.A.P.P.Y. ) and
, information, and sponsoring educational seminars.
Evaluation la: Data indicating the rate of chemical abuse
, are reviewed to identify trends and effects
of educational efforts.
, Method lb: Further investi ate availabilit of funds and
g Y
feasibility of coordinating a provider-based
, information sharing session and resource to
increase awareness of programs and identify
service gaps.
, Evaluation lb: Based on this effort, service gaps will be
identified and resources more closely
coordinated. The need to coordinate this
, type of session on a more frequent basis will
be determined based on feedback.
, ----
Method lc: Public Health staff will participate in City-wide
efforts to decrease chemical abuse as directed by
, the Mayor and City Drug Prevention Team.
Evaluation lc: Follow-up reports of the Team will identify
, the impact and success of efforts .
� Method ld: Chemical Health education will be provided via a
number of different programs and efforts:
� 1 . Education on chemical health including opium and
tobacco use is provided to SEA individuals in the
ESL classroom setting.
,
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Mental Health^/Chemical Dependency ObjectivesfMethodsfEvaluation ,
2 . Print material and verbal counseling regarding ,
chemical use (drugs, alcohol and tobacco) is
provided to women upon pregnancy testing performed
through the DPH Family Planning program.
3. Working with other appropriate agencies to �
coordinate and provide education to the community
- on chemical health (i.e. "Race, Class and ,
Addiction" seminar)
4 . Participating in activities related to Chemical ,
Health Awareness Week including prevention and
educational activities.
Evaluation ld: Data and information will be collected to ,
identify the number of individuals who have
been provided with education through these
activities. ,
Method le: Referrals to other community resources are made to ,
clients and patients who are interested in
receiving chemical health information, counseling,
and/or treatment which the St. Paul Division of ,
Public Health does not directly perform.
Evaluation le: Resources for referrals updated regularly in ,
order to provide accurate referrals
information. Data could be collected to
indicate the volume and type of referrals
made. ,
• OBJECTIVE 2: TO DECREASE BY 5$ FROM 1988 LEVELS, THE NUMBER OF ,
ST. PAUI, RESIDENTS, INCLUDING TEENAGERS, WHO SMORE
CIGARETTES BY DECEMBER 31, 1995. ,
(PROBLEMS 28)
Method 2a Continued involvement in D-Day campaigns and ,
working with the American Lung Association to
encourage smokers to quit smoking. �
Evaluation 2a: Data collected by other agencies can be
reviewed to determine the number smokers who
have quit smoking due to these combined �
efforts .
---- �
102 ,
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, Mental Health�Chemical Dependency ObjectivesfMethodsfEvaluation
� Method 2b: Continue to work with the St. Paul community
clinics to train staff to serve as facilitators
working with their own clients on smoking
� cessation efforts .
Evaluation 2b: Data can be collected to identify the total
number of clients who have taken part in the
, smoking cessation programs, and those who
have successfully quit smoking.
, Method 2c: Will encoura e chemical abuse treatment facilities
9
to evaluate and support restrictions on all
, chemical addictions including tobacco by going
Smoke-Free.
, Evaluation 2c: Data can be collected indicating the number
of chemical abuse treatment facilities who
have gone Smoke-Free.
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,
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Mental Health/Chemical Dependency Inventory
Mental Health ,
o Access I and II, 275 East 4th Street, St. Paul �
o Alliance for the Mentally I11 of Minnesota, 1595 Selby Ave. , St.
Paul
o Apartment Network of People, Inc. , 812 North Hazel, St. Paul �
o Boston Health Care Systems, 563 Payne Ave. , St. Paul
o Center for Human Development of White Bear Lake, Inc. , 1310 East
Hwy 96, White Bear Lake ,
o Children's Hospital, 345 North Smith, St. Paul
o Chrysalis - Center for Women, 550 Rice Street, St. Paul
o Comprehensive Psychiatry Clinic, 640 Jackson Street, St. Paul
o Crisis Program - St. Paul-Ramsey Medical Center. 640 Jackson, St. ,
Paul
o Dayton Board and Care, 740 Dayton Avenue, St. Paul
o Face to Face Health and Counseling Service, 642 E. 7th Street, St. ,
Paul
o Familystyle Homes, 721 5th Avenue Northwest, New Brighton
o Frances Residence I, 1735 Arlington Avenue E. , St. Paul �
o Guild Hall, 286 Marshall, St. Paul
o HealthEast, 559 Capitol Boulevard, St. Paul
o Health Care for the Homeless Project, 153 Concord, St. Paul
o Hearing Impaired Health and Wellness Services, 640 Jackson, St. �
Paul
o Hewitt House of People, Inc. , 1593 Hewitt Avenue, St. Paul
o Hoikka House, 393 Chesnut Street, St. Paul �
o Jewish Family Service, 1546 St. Clair, St. Paul
o Marshall Residence, 1491 Sherburne, St. Paul
o Mental Health Resources, Inc. - MHR, 1821 University Ave. , St. Paul
o Minnesota Depressive and Manic Depressive Association, 2414 S. 7th �
Street, Minneapolis
o New Foundations, 796 Capital Heiqhts, St. Paul
o North End Health Center, 135 Manitoba, St. Paul ,
o Oakland Home, 97 North Oxford, St. Paul
o People Incorporated, 379 University Avenue West, St. Paul
o Peterka House, Inc. , 513 Portland Avenue, St. Paul ,
o Petra Howard House of People Inc. , 700 E. 8th St. , St. Paul
o Phalen Area Community Council, 909 Payne Avenue, St. Paul
o Ramsey County Mental Health Clinic, 529 Jackson Street, St. Paul
o Safe House, 487 Grand Avenue, St. Paul �
o Seed Program (Supportive Experiential Education for Mentally I11 ) ,
900 Albion Street, St. Paul
o St. Joseph's Hospital, 69 West Exchange, St. Paul ,
o St. Paul-Ramsey Medical Center, 640 Jackson Street, St. Paul
o United Hospital, 333 North Smith, St. Paul
o White Bear Lake Area Community Counseling Center, 4739 Division ,
Avenue, White Bear Lake
o YES/NEON, PO Box 14958, Minneapolis
,
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�
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Mental Health/Chemical De ndencv Inventory
, Chemical Dependency
o A1-Anon/Alateen Information Center, 1538 White Bear Avenue, St.
, Paul
o Alcoholics Anonymous St. Paul Area Intergroup Central Office, Inc. ,
951 East 5th Street, St. Paul
� o Alcoholics Anonymous St. Paul Club, 520 North Robert Street, St.
Paul
o Alternative Homes, 1210 Albemarle, St. Paul
, o Catholic Charities, 215 Old 6th Street, St. Paul
o Christ Center - Union Gospel Mission, 435 University Ave. , St. Paul
o Center for Hwaan Development of White Bear Lake, Inc. , 1310 East
Hwy 96, White Bear Lake
, o Chrysalis - Center for Women, 550 Rice Street, St. Paul
o Cocaine Anonymous, 931 West Broadway, Minneapolis
o Cocanon, 110 Ridgewood Drive, Hopkins
� o Conceptual Counseling, Inc. , 245 East 6th Street, St. Paul
o Family Service of Greater St. Paul, 166 E. 4th Street, St. Paul
o Granville, a Fairview Treatment Center, 68 West Exchange St. St.
, Paul
o HealthEast - St. Joseph's Treatment Center, 69 West Exchange, St.
Paul
o Health Care for the Homeless Project, 153 Concord, St. Paul
� o Hearing Impaired Health and Wellness Services, 640 Jackson, St.
Paul
o Help Enable Alcoholics Receive Treatment (H.E.A.R.T. ) , 389 North
, Oxford Street, St. Paul
o Hispanos en Minnesota, 179 East Robie Street, St. Paul
o Institute on Black Chemical Health, 2614 Nicollet Ave. S. ,
Minneapolis
� o Juel Fairbanks Chemical Dependency Services, 806 N. Albert Street,
St. Paul
o Mothers Aqainst Drunk Driving, 450 North Syndicate, St. Paul
, o Narcotics Anonymous, 310 E. 38th Street, Minneapolis .
o Ramsey County Chemical Assessment and Referral Unit, 160 E. Kellogg
Blvd. , St. Paul
, o Ramsey County Receiving Center (Detox) 155 E. 2nd St. St. Paul
o Rebuild Resources, 602 Prior Avenue North, St. Paul
o Riverside Medical Center, 2450 Riverside Ave. Minneapolis
o Senior Chemical Dependency Program, 570 Capitol Blvd. , St. Paul
� o Sarah Family Programs, 919 West Armstrong Ave. , St. Paul
o St. Anthony Residence - Catholic Charities, 2300 Wycliff, St. Paul
o St. Joseph's Hospital, 69 West Exchange, St. Paul
, o St. Paul-Ramsey Medical Center, 640 Jackson, St. Paul
o Three R's Counseling Center, 1304 University Ave. NE, Minneapolis
o United Hospital, 333 North Smith, St. Paul
, o University Hospital and Clinic, Harvard & E. River Road,
Minneapolis
o Women for Sobriety, 1150 Palace Ave. , St. Paul
�
, 105
� ��-ig�3
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�
�
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,
,
Communicable Disease Problems/Goals
, -----
� PROBLSM 32: Increasing prevalence of all sezually transmitted
diseases **
GOAL 32: To reduce to a minimum the incidence of all sexually
, transmitted diseases
` PROBLEM 33: Prevalence of vaccine-preventable diseases, includinq
measles and hepatitis **
, GOAL 33: To eliminate the incidence of vaccine-preventable
diseases, including measles and hepatitis
� -----
PROBLEM 34: Increasing prevalence of HIV infection; disproportionate
, prevalence among Black and Hispanic populations
GOAL 34 : To eliminate the spread of HIV infection amonq all
populations and to assure adequate and culturally
� appropriate services for all persons infected with the
virus
� PROBLEM 35: Numbers of adolescent males at hi h risk for HIV
9
infection
� GOAL 35: To eliminate the spread of HIV infection among all
populations and to assure adequate and culturally
� appropriate services for all persons infected with the
virus
� PROBLEM 36: Existence of otential for s read of communicable
P P
disease by sick workers, including but not limited to
, spread of Hepatitis B from accidental needle sticks, to
health care workers, day care providers, first
responders, solid waste handlers, etc.
, GOAL 36: To eliminate the spread of vaccine-preventable diseases
by sick workers and to reduce to a minimum the spread of
� all other communicable_diseases by sick workers
, ** Identified as one of thirteen Highest Priority Problems by St.
Paul-Ramsey County Community Health Services Advisory Committee
, 106
,
�
Communicable Disease Problems/Goals
----- ,
PROBLEM 37: Increasing prevalence of Hepatitis B carriers �
GOAL 37: To eliminate the incidence of vaccine-preventable
diseases, including measles and hepatitis
,
,
�
�
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�
�
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i
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. �
107 ,
,
,
Communicable Disease Rey Data
�
1. In 1989, primary and secondary syphilis incidence in Minnesota was
1.4 cases per 100,000; the incidence rate in 1990 is projected at
� 2.5 cases per 100,000, an increase of 78� over 1989.
2. In 1989, gonorrhea incidence in Minnesota was 90 cases per
, 100,000; the incidence rate in 1990 is projected at 98 cases per
100,000, an increase of 9� over 1989.
� 3. Chlamydia is the most frequently reported STD in Minnesota. In
1989, chlamydia incidence was 182 cases per 100,000; the incidence
rate in 1990 is projected at 210 cases per 100,000, an increase of
18� over 1989. Peak prevalence is in 15-19 year old females, and
� is also higher among Blacks. (MDH: Confrontin AIDS: Pro ress
and Future Directions for HIV/STD Prevention, 12 90)
� 4. There were 267 confirmed measles cases, 5 confirmed pertussis
cases, and 8 confirmed Hepatitis B cases in St. Paul in 1990.
(St. Paul Division of Public Health Epidemiology) In 1989, 19
� Hepatitis B carriers were identified and tracked by the St. Paul
Division of Public Health; in 1990, 23 carriers were identified
and tracked. Due to implementation of a system to track Hepatitis
B carriers in St. Paul, 25 carriers were identified and tracked by
� SPDPH during the first quarter of 1991.
5. Nationally, 43� of reported AIDS cases have occurred among people
, of color. In Minnesota, 14$ of all AIDS cases have occurred among
people of color, which is disproportionate given that people of
color represent 3.6� of the total State population.
� 6. AIDS/HIV Data: February, 1991
AIDS Surveillance Data (Data cumulative through February 18, 1991)
� RESIDENCE= (AT ONSET) CASES ($)
City of Minneapolis 465 55$
, City of St. Paul 92 11�
7-County Metro (other
than Mpls/St. Paul) 187 22�
Greater Minnesota 107 12�
� 851 100$
RACE/ETHNICITY CASES ($)
, White (not Hispanic) 724 85$
Black (not Hispanic) 90 10�
Hispanic 26 3$
� American Indian/
Alaskan Native 7 1�
Asian/Pacific Islander 4 <1�
851 100�
�
,
108
,
,
Communicable Disease Rey Data
-AID HIV Infection Surveillance Data Data cumulative throu h �
Non S ( g
February 1, 1991)
RACE/ETHNICITY CASES $ �
White (not Hispanic) 1, 175 75�
Black (not Hispanic) 290 18� ,
Hispanic 62 4�
American Indian/
Alaskan Native 39 2� �
Asian/Pacific Islander 9 1�
1,575 100�
7. The tables on the following three pages illustrate historic trends �
in Room 111 utilization from 1972-1990, including the introduction
for HIV testing in 1985, the numbers and types of STD cases �
diagnosed at Room 111 during the same period of time, and the
numbers and types of STD cases reported by month at Room 111
during 1990.
,
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109 �
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Communicable Disease Rey Data
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,
�
Communicable Disease Ob7ectives/Methods/Bvaluation
Ramsev County Public Health Department
�
o OBJECTIVB 1: BY D8CB1rIBBR 31, 1995 TO RSDUCB THB INCIDBNCB OF �
ALL COI�II�IiJNICABLB DISSASBS, INCLUDING SBXUALLY
TRANSMITTBD DISBASBS, IN RAMSBY COUNTY BY 5$ FROI�
1988 FIGURSS. �
(PROBLSMS 32-37)
Method la: Provision of health education to revent the �
P
occurrence and spread of sexually transmitted
disease in Suburban Ramsey County. �
(Problem 32, 34, 35)
Evaluation la: Data are collected on clients served and �
services provided. Annual Disease,
Prevention & Control (D,P&C) activities in
Suburban Ramsey County include 2,500 health �
education and screening encounters.
Method lb: Provision of health education for revention �
P
of transmission of the HIV virus to high risk
Ramsey County residents. �
(Problem 34, 35)
Evaluation lb: Data are collected on numbers of persons
receiving Health Education information and �
subject areas covered. Health education
services in Suburban Ramsey County are
projected to serve 2,000 adolescents and �
2,000 adults in 1991.
Method lc: Continue convenin and leadeshi of the �
9 P
community-based Ramsey County tiIV Advisory
Committee that includes staff and �
representatives from various County
departments, and community orqanizations.
(Problem 34, 35) �
Evaluation lc: Information is collected on meeting
attendance, community representation, and �
initiatives/plans developed and implemented
as a result of Committee efforts.
----- ,
113 ,
,
�
Communicable Disease Ob'iectives/Methods/Bvaluation
�
, Method ld: Establishment of a traininq program for
County employees who work with clients that
are at risk for HIV infection.
� (Problem 34, 35, 36)
Evaluation ld: Information is collected on attendance and
� subjects of training program efforts.
1 Method le: Provision of health education, immunizations,
health screening, and disease investigations
to prevent the occurrence and spread of
� communicable disease in Suburban Ramsey
County.
(Problem 33, 36, 37 )
, Evaluation le: Data are collected on clients served and
services provided. Annual D,P&C activities
in Suburban Ramsey County include 2,000
� immunizations provided; 100 communicable
disease investigations; and 2,500 health
education and screening encounters.
� -----
Method lf: Five (5) immunization clinics per month are
� provided at three (3) Suburban Ramsey County
sites.
(Problem 33, 36)
� Evaluation lf: Data are collected on numbers and types of
clinic visits. Approximately 1,200
, clinic-related visits were made in 1990.
� Method lg: Mantoux testing administration and reading
available at Fairview Community Center five
(5) days/week.
, (Problem 36)
Evaluation lg: Data are collected on Mantoux administered,
, results, and referrals as appropriate.
�
, 114
,
�
Communicable Disease Ob]ectives/Methods/Bvaluation
�
Method lh: Hepatitis B Vaccination: �
a. Educational information provided to
clients on home visits
b. Clients encouraged to attend Hepatitis B �
immunization clinics in the City (i.e. West
Side Health Center, SPDPH, McDonnough)
(Problem 36, 37 ) �
Evaluation lh: Data are collected on numbers of clients
served and referrals as appropriate.
----- �
Method li: Provision of accurate Public Health �
information to health, education, and social
service professionals who can address Public
Health issues in their work with clients. �
(Problems 32-37 )
Evaluation li: Data are collected on nwnber and content of
consultations and classes provided. Five �
hundred health consultations and classes to
1,500 individuals at various facilities are
provided annually. �
o OBJECTIVE 2: TO FOSTBR AND ASSURB SBRVICS DBLIVSRY BFFICIBNCY, �
COORDINATION OF SSRVICBS, AND OPBN LINBS OF
COMMUNICATION i�TITHIN AND AKONG DISCIPLINSS. �
(PROBLBI�IS 32-37)
Method 2a: Continue/ex and collaboration with other �
P
Health Departments (SPDPH, MDH, other 6 metro
Counties) to organize and coordinate metro & �
local epidemiology efforts.
Evaluation 2a: Information will be collected on �
collaboration efforts & outcomes.
----- ,
'
115 ,
�
�
Communicable Disease Objectives/Methods/Evaluation
�
Method 2b: Implement a planning team to include
� community clinics, other other community
providers, and Ramsey County Community Human
Services Department staff to analyze and
implement as appropriate a series of
� alternative service delivery strategies
which might include:
� 1. Conducting a study on a random sample of
family day cares to determine immunization
levels of their children.
� 2. Developing a program which provides tangible
incentives for participation in immunization
clinics, i.e. giving out coupons for food,
� diapers, etc. (work with local Foundations
for funding, & local retailers for in-kind
contributions. )
, 3. Developing a Ramsey County employee
immunization program in cooperation with
other County departments.
� 4. Focusing day care consultation program on
family day cares; exploring co-visiting each
� family day care with RCCHS licensers once a
year, looking at homes relative to health/
safety/sanitation, etc. ; reviewing
� immunization status; providinq inservices
with day care licensers and have them look
for health problems & hand out health
information during their inspections.
� 5. Encouraging physicals and immunizations for
family day care providers (not required by
� Rule. )
6. Providing expanded tetanus and flu
� immunization clinics onsite at senior housing
locations.
� Evaluation 2b: Information will be collected on planning
efforts and outcomes.
� -----
�
, 116
�
�
Communicable Disease Ob�ectives/Methods/8valuation
�
St. Paul Division of Public Health/Ramsey County Public Health
Department �
o OBJECTIVE 1: TO ASSURE TBE PROVISION OF HIGH QUALITY,
ACCBSSIBLB CLINIC-BASBD CARS ON A SLIDING FB8 �
SCALB TO ALL LOW-INCOMB UNINSURBD AND
UNDBRINSURBD RAIrISBY COUNTY R13SIDBNTS.
(PROBLSI�IS 32-37) �
Method la: Funding is provided to seven Community �
Clinics (Face to Face Health and Counseling
Center, The Family Tree, Health Start,
Helping Hand Health Center, Model Cities �
Health Center, North End Health Center, and
West Side Community Health Center) to
subsidize the cost of primary and preventive �
health care services, including medical,
dental, family planning, and general and
targeted health education on a sliding fee
scale to low income, under- and uninsured �
Ramsey County residents.
Evaluation la: Data are collected on numbers of clients and �
services provided as well as financial
status. An estimated total of 117,870 visits
were provided to 56,920 patients in 1990. �
(City and County fundinq covers only a
portion of the total costs for this level of
service. )
----- �
�
o OBJECTIVE 2: TO MINIMIZB THB TRANSMISSION OF HIV AMONG IV DRUG
USBRS IN RAMSBY COUNTY. �
(PROBLEMS 34-35)
Method la: Work with The Ramsey County HIV Advisory �
Committee, MAP, and other appropriate
aqencies to study the efficacy of community �
distribution of clean needles.
Evaluation la: Findings of the study will be documented and �
acted on as appropriate.
117 ,
�
� c'ommunicable Disease ObjectivesfMethods/Evaluation
� �t. Paul Division of Public Health
� OBJECTIVE l: TO DECREASE THE INDICENCE OF SE%IIALLY TRANSMITTED
� DISEASES INCLUDING SYPHILIS, GONORRHEA AND
CHLAMYDIA BY 2$ FROM 1988 LEVELS FOR ST. PAIIL
RESIDENTS BY DECEMBER 31, 1995.
, (PROBLEM 32)
� Method la: The St. Paul Division of Public Health provides
various services through its clinical programs,
and especially through Room 111, including
� education, screening and treatment of sexually
transmitted diseases.
� Evaluation la: Local and state data is reviewed and
monitored to identify trends and increasing
and decreasing disease rates. Based on this
data, services may be modified and/or
� targeted to certain populations . In 1990,
individuals made 6, 105 visits to Room 111 for
sexually transmitted disease services .
� ----
Method lb: Health education regarding avoidance of, and
� protection against sexually transmitted diseases
is provided to patients seen in SPDPH clinics, and
also to attendees at various community meetings
, and school presentations.
Evaluation lb: See la evaluation above. In 1990
� approximately 1,295 persons were provided
with health education in addition to persons
receiving education through DPH clinics .
� ----
Method lc: Continue to routinely provide an abbreviated HIV
, counseling and testing format to high risk
individuals seeking STD related services .
� Evaluation lc: Data will be collected identifying the number
of STD clients receiving HIV counseling and
testing.
� ----
�
, 118
,
Communicable Disease Objectives�Methods/Evaluation ,
• OBJECTIVE 2: TO INCREASE THE RATIO OF HIGH RISK INDIVIDUALS �
RECEIVING HIV COUNSELING AND TESTING BY 5$ BY
DECEMBER 31, 1995.
(PROBLEMS 34 AND 35)
---- �
Method 2a: Room 111 at the St. Paul Division of Public Health �
is the Minnesota Department of Health Counseling
and Testing Site for the East Metro area, and
plans to continue to provide voluntary HIV
counseling and testing. �
Evaluation 2a: Local and state data is reviewed and
monitored to identify trends and increasing �
and decreasing transmission and disease
rates . Based on this data, services may be
modified and/or targeted to certain �
populations . In 1990, clients were seen in
4,218 visits for HIV testing and counseling.
---- �
Method 2b: Continue to provide "enhanced" services to HIV
positive persons, including medical and laboratory �
evaluation.
Evaluation 2b: Data is collected indicating the number of
persons receiving enhanced services . �
Method 2c: Facilitate and participate in studies/surveys ,
conducted by CDC, MDH, NIDA, etc . to assess the
seroprevalence of HIV infection. �
Evaluation 2c: Data is available related to the specific
survey; recommendations for the feasibility
of changing service provision, outreach and �
education to high risk populations will be
assessed.
---- �
Method 2d: Health education regarding avoidance of, and ,
protection against HIV transmission is provided to
patients seen in DPH clinics, and also to
attendees at various community meetings and school
presentations . ,
�
119 ,
,
� Communicable Disease Objectives/Methods�Evaluation
� Evaluation 2d: See evaluation 2a. In 1990 approximately
2,503 persons were provided with health
education in addition to persons receiving
education through DPH clinics .
, ----
� Method 2e: Continue and expand work with the corrections
systems to provide onsite HIV counseling and
testing services within detention facilities.
� Evaluation 2e: Data will be collected indicating the number
of persons receiving counseling and testing.
� ----
Method 2f: Work to identify a means to develop rapport with
� the two St. Paul "gay bars" to allow DPH staff to
provide educational materials, referral cards, and
condoms at the bars.
� Evaluation 2f: Data will be collected as to the success and
completion of this effort.
� ----
• OBJECTIVE 3: TO INCREASE THE RATE OF ADEQIIATE IlrlMUNIZATION TO
90$ OF TODDLER AGE CHILDREN BY DECEMBER 31, 1995
� IN ORDER TO DECREASE THE SPREAD OF VACCINE
PREVENTABLE DISEASE.
(PROBLEMS 33 AND 37)
� ----
� Method 3a: Immunizations are provided at the St. Paul
Division of Public Health during weekday mornings
from 8-10:30. Additionally, two evening clinics
are held on the second and fourth Mondays from 4-
� 6:30.
Evaluation 3a: Immunization status of all individuals that
� come in contact with Division of Public
Health programs are tracked to ensure that
proper additional immunizations are given.
� In 1990, 6, 193 patients received 9,848
immunizations at DPH clinics.
� ----
�
, 120
�
Communicable Disease ObjectivesfMethods/Evaluation �
Method 3b: Immunizations, tracking and education are provided �
through the Well Child programs held during WIC
clinics. This outreach effort to provide
immunizations at locations where high risk clients
come for service. These clinics were started in �
1990. Since that time, additional clinics have
been started so that these services are now
provided at 4 locations during 19 WIC clinics each �
month.
Evaluation 3b: Immunization status of all individuals that
come in contact with Division of Public �
Health programs are tracked to ensure proper
followup immunizations are given.
Approximately 200 immunizations are expected �
to be given each month at the current level
of clinics . In addition, 300 persons are
assessed for completeness of immunizations �
and tracked.
Method 3c: Vaccine is rovided free of charge to a variety of �
P
neighborhood community clinics, homeless projects
and colleges; primarily those who lack financial �
resources to pay for the vaccine.
Evaluation 3c: In 1990 6,204 doses of vaccine was provided
to eight agencies . These agencies must turn �
in quarterly reports to the Division,
documenting the number of doses given
compared to the amount of vaccine provided. �
Method 3d: The Division' s Hepatitis B program is focused on �
decreasing the number of persons infected with the
Hepatitis B virus by educating parents and
completing the series of three hepatitis B �
immunizations in 40� of those infants and children
identified at high risk of contracting the
disease. Tracking of individuals is performed to �
ensure completion of full series of vaccine.
Evaluation 3d: In 1990 467 Hepatitis B immunizations were ,
given by the Division of Public Health, and
411 individuals were monitored and tracked.
---- �
�
121 ,
r
, Communicable Disease Obiectives�Methods/Evaluation
� Method 3e: Current and future health education activities
promote the need for appropriate immunizations for
all children through the production of videos and
brochures, community presentations, and one-to-one
� education made to high risk populations .
Evaluation 3e: Data are collected on the number of
, individuals receiving education on the
importance of proper immunization scheduling.
� Method 3f: Immunization records of children enrolled in
licensed St. Paul Day Care centers are reviewed to
� ensure appropriate immunization level.
Evaluation 3f: By 1995, less than 2$ of toddlers in licensed
� child care centers will have incomplete
immunization histories.
� Method 3 : The Division assures or rovide health screenin
9 P 9
to new refugees located in St. Paul within 6 weeks
� of their arrival to minimize the spread of various
vaccine preventable diseases
Evaluation 3g: In 1990, 65� (481) of new refugees in St.
� Paul refugees were screened at the Division
.,
of Public Health.
, ----
Method 3h: A surveillance system is maintained to carry out
� investigations, special studies and data analysis
and to institute appropriate control measures
against conditions of public health significance
in the community.
� Evaluation 3h: Surveillance systems will be evaluated to
ensure that they allow for tracking of
� disease trends and early identification of
possible outbreaks . This information is used
to prevent further spread of disease and
target efforts to high risk populations .
� ----
�
�
, 122
�
Communicable Disease ObjectivesjMethods/Evaluation ,
Method 3i: Will evaluate the current SPDPH immunization �
program and identify alternate programs
(increasingly community based) to ensure increased
immunization rates .
Evaluation 3i: Progress toward evaluation and revision of �
programs will be monitored.
---- �
Method 3j : The SPDPH supports and is involved with the
activities of the Hepatitis B Coalition of �
Minnesota, which is working toward the
reduction/elimination of Hepatitis B.
Evaluation 3j : The activities of the Coalition are �
monitored to ensure efficient and effective
programs and coordination of activities is
maintained. �
• BJECTIVE 4: TO DECREASE BY 5� FROM 1988 LEVELS, THE SPREAD OF �
O
NON-VACCINE PREVENTABLE COMMUNICABLE DISEASES BY
December 31, 1995, AND ENSURE TBAT THE NEW �
TUBERCULOSIS CASE RATE AILL NOT E%CEED 5 CASES.
(PROBLEM 36)
Method 4a: Screenin for Tuberculosis (TB) is provided to �
g
high risk individuals including foreicfn born
persons; IV drug users; homeless persons; �
residents of nursing homes, correctional
institutions, halfway houses; and those with other
high risk factors . �
Evaluation 4a: In 1990, 1,534 individuals were screened for
tuberculosis through the Division of Public
Health. Follow up and/or referral for �
further medical evaluation and treatment is
performed when indicated. In 1990, 223
individuals received further evaluation. �
Method 4b: Education, chemotherapy and followup of active TB �
cases is performed in order to contain the spread
of the disease. Information and preventive
therapy is provided to infected contacts of TB ,
cases so that they do not break down with active
disease.
. �
123 ,
�
, Communicable Disease ObjectivesfMethodsfEvaluation
� Evaluation 4b: In 1990, 240 individuals were provided with
preventive therapy to limits the spread of
tuberculosis.
� ----
Method 4c: A surveillance system is maintained to carry out
, investigations, special studies and data analysis
and to institute appropriate control measures
against conditions of public health significance
in the community.
� Evaluation 4c: Surveillance systems will be evaluated to
ensure that they allow for tracking of
� disease trends and early identification of
possible outbreaks. This information is used
to prevent further spread of disease and
� target efforts to high risk populations.
� Method 4d: DPH staff teach classes on topics such as
handwashing and preventing the spread of
communicable disease to child care center staff,
� as offered by Resources for Child Caring.
Evaluation 4d: Data are collected which should indicate a
decrease in reported diseases such as
� Giardia, Psittacosis and Strep.
, Method 4e: The Division assures or provides health screening
to new refugees located in St. Paul within 6 weeks
, of their arrival to minimize the spread of various
communicable diseases including TB and sexually
transmitted diseases .
� Evaluation 4e: In 1990, 65$ (481) of new refugees in St.
Paul refugees were screened at the Division
of Public Health. Other refugees are tracked
� to ensure that they are screened by another
health care provider.
� Method 4f: Home visits are made to all ersons started on
P
meds for TB infection (positive mantouxs) to
� evaluate medication compliance and educate
patients about the importance of completing the
medication plan.
�
, 124
�
Communicable Disease ObjectivesjMethods/Evaluation ,
Evaluation 4f: Data are collected and analyzed to identify �
compliance rates .
(NOTE: For additional information on the St. Paul Division �
of Public Health activities related to refugee health and
communicable disease control, see the grant proposals ,
submitted to the Minnesota Department of Health. )
�
�
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�
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�
�
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125 �
�
�
Communicable Disease Inventory
� o Summa of Minnesota De rtment of aealth HIV-Related Grants
i'Y Pa
and Contracts for FY 1991
� PROGRAM AREA FUNDING
Seroprevalence $378,081
, Testing & Counseling $328,272
Prevention $1,693, 189
Case Management $539,596
� Professional Development $91,869
Total: $3,031,007
o Summary of Minnesota Department of Health Fundinq to St. Paul,
� Minneapolis, and Hennepin and Ramsey Counties for FY 1991
o Seroprevalence
� Proqram Funding
Memorial Blood Center of Minneapolis $43,943
American Red Cross Blood Svcs. , St. Paul Region $232,560
(Clinic-Based Surveys)
� Hennepin County Community Health $51,203
St. Paul Division of Public Health $33,875
St. Paul-Ramsey Medical Center $2, 100
� Twin Town Treatment Center, St. Paul $1,200
Eden House, Minneapolis $1,200
Meadowbrook Women's Clinic, Minneapolis $6,000
� Midwest Health Center for Women Minnea olis 6 000
Total, St. Paul Ramsey County: $269,735
Total, Minneapolis/Hennepin County: $108,346
� o Testing � Counseling
Program Funding
Hennepin County $153,750
� City of St. Paul $66, 125
Minneapolis Health Department $3,000
St. Paul Division of Public Health $5,000
Planned Parenthood $12,077*
� West Suburban Teen Clinic $4,462
Annex Teen Clinic, Robbinsdale $3,723
West Side Health Center $5,800
� Boynton Health Service $3,600
Cedar-Riverside People's Center $1,469
Face to Face Health & Counseling Service $2,243
� Southside Community Clinic, Minneapolis $1,500
Indian Health Board Minnea olis $13 950
Total, St. Paul Ramsey County: $83,630
Total, Minneapolis/Hennepin County: $180,992
, * Serves persons residing throughout State, including metro area.
Totals for St. Paul/Ramsey & Minneapolis/Hennepin include only
� funding directed specifically within these jurisdictions.
� 126
r
�
Communicable Disease Inventory
o Summary of 1rlinnesota Department of Health Funding to St. Paul, �
Minneapolis, and Hennepin and Ramsey Counties for FY 1991, cont.
o Prevention �
Pr=ogram Fundinq
Minneapolis Health Department $27,311*
University of Minnesota/Adolescent Health Program $160,038 ,
Women Helping Offenders/Youth, Minneapolis $39,660
Women Helping Offenders/Adult, Minneapolis $36,860
Turning Point, Inc. , Minneapolis $70,000 �
Catholic Charities, Minneapolis & St. Paul $31,941
Minnesota AIDS Project $384,909*
Minneapolis Youth Diversion Program $43,373 �
Indian Health Board of Minneapolis $32,770
Centre for Asian and Pacific Islanders, Minneapolis $29,623
University of Minnesota Hemophilia Center $29,400* �
Council on Asian-Pacific Minnesotans $24,700
Hennepin County Corrections $48,387
Hennepin County HIV Intervention & Models Program $62,042 �
Hennepin County Youth Program $48,814
Face to Face Health & Counseling Service $7,785
Spanish Speaking Affairs Council, St. Paul $116,802
Lutheran Social Services, Minneapolis & St. Paul $38,939 �
Minneapolis Urban League $107,738
Minnesota Department of Hwaan Services $27,961*
Ferris Marketing, Inc. $104,700* �
Minnesota Minority Media Coalition $68,000*
Communication Technologies, Inc. $9,976*
University of Minnesota, Center for Urban &
Re ional Affairs $16 277* �
Total, St. Paul Ramsey County: $160,027
Total, Minneapolis/Hennepin County: $827,818
o Case Manaqement `
Program Funding
Metropolitan Mount Sinai Medical Center $156,265 ,
Minnesota AIDS Project $670,557*,**
Ramse Foundation $137 774
Total, St. Paul Ramsey County: $137 774
Total, Minneapolis/Hennepin County: $156,265 �
* Serves persons residing throughout State, including metro area.
Totals for St. Paul/Ramsey & Minneapolis/Hennepin include only �
funding directed specifically within these jurisdictions.
** Funding to MAP for case management includes $425,000 from the ,
Minnesota Department of Human Services and $245,557 from the
Minnesota Department of Health.
�
127 �
,
�
Communicable Disease Inventory
�
o Testing and Counselinq Centers
� As of January, 1991, there were 8 designated Counseling and Testing
Sites for AIDS virus antibody testing, located in St. Paul,
Minneapolis, Duluth, Rochester, St. Cloud, Winona, Moorhead, and
� Mankato. In addition, 19 clinics received MDH reimbursement for
providing their clients with testing and counseling statewide: four
located in St. Paul, seven located in Minneapolis, four located in
� Metro area suburbs, and four in Greater Minnesota. (Note: Planned
Parenthood, based in St. Paul, offers testing and counseling ,
throughout the State. )
� Total reimbursement for testing and counseling is $28.75 per
encounter: $25.00 for counseling and $3.75 for testing.
� o Fundinq and Availability of AZT
� The Minnesota Department of Human Services spends between $8,000 and
$11,000 per month for AZT. Anyone who applies to DBS will receive
AZT; currently there are 87 people enrolled in this program.
, o COBRA
, The HIV Insurance Program (COBRA) is funded at $135,000 statewide for
FY 1991. At present, 30 persons are beinq served: 27 men, and 3
women. Persons on SSDI are covered for 29 months.
� o Other Prevention/Education Resources
, American Red Cross - St. Paul Area Chapter, 100 South Robert Street,
St. Paul
Community Clinics
, Health Care for the Homeless Project, 153 Concord Street, St. Paul
Minnesota Department of Aealth, 717 S.E. Delaware Street, Minneapolis
�
,
�
�
, 128
,
�
Income/Access to Care Problems/Goals
� h 1 are rticularl amon workin
PROBI,BI�I 38: Lack of access to ea th c , pa. y q q
poor, and children living in poverty **
� GOAL 38: To assure access to health care for all residents of
Ramsey County
, PROBLEM 39: Aigh prevalence of chronic disease in minority and
low-income populations
� GOAL 39: To reduce the incidence of chronic disease in minority
and low-income populations
�
** Identified as one of thirteen Highest Priority Problems by St.
, Paul-Ramsey County Community Health Services Advisory Committee
�
�
�
�
,
�
�
�
,
,
� 129
,
�
Income/Access to Care Rey Data
1 8� of Minnesotans are uninsured at an one time• r
1. Approximate y y ,
5.8$ of Minnesotans are uninsured throughout the year, and 4.9�
are uninsured for part of the year. (MN Health Care Access �
Commission Interim Report to the Leqislature, February, 1990)
2. Thirty percent of the uninsured in Minnesota are children under 19 ,
years of age; 41� are between the ages of 22-54 years.
3. Thirty-five percent of the families enrolled in the Children's �
Health Plan are underinsured, evidenced by the fact that they have
some form of insurance which does not adequately cover primary
care services.
4. During State Fiscal Year 1989, there were 51,821 Medical �
Assistance participants in Ramsey County; a total of 31, 154
children between the ages of 0-18 and 13,882 women between the �
ages of 19-49 were eligible for M.A. During 1988, a total of
14, 190 children in Ramsey County were estimated to be living below
185� of poverty, and 1,810 pregnant females were estimated to be �
living below 200$ of poverty.
5. The table and graphic on the following page illustrate the
significant income disparities found when comparing White, Black �
and American Indian residents in St. Paul in 1980. While there
were far more White households in St. Paul on public assistance
(6,457 ) than Black ( 1, 149) or American Indian households (251) , �
the proportion of White families under the poverty level (6.2$)
was far lower than the proportions found among Blacks (23.5�) or
American Indians (25.2$) . Unfortunately, complete data from the
1990 census were not available at the time that this Plan was �
developed, but trends over the last decade would indicate that
income disparities have increased durinq the 1980's; further, 1990
data will also show significant differences between income levels �
of Whites and Southeast Asians, which did not show up in the 1980
figures.
�
. �
�
,
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130 ,
,
�
Income/Access to Care Rey Data
�
INCOME CHARACTERISTICS
, OF SAINT PAUL RESIDENTS B Y RACE, 1980
Census category Indian Black White
� Total persons........................ 2558 13305 245795
Total famlltes........................ 516 3052 59800
� Median famlly income............ 511632 $137Z2 $21337
Mean famlly income............... 513373 $16783 524205
Households on public assist.... 251 1149 6457
Famlties under poverty level.... 130 716 3736
Petcent............................ 25.296 23.596 6.2%
� Persons <7596 poverty lncome.... 16.096 15.49fo 5.596
Persons <12596 poverty fncome. 36.496 31.296 12.796
Persons < 20096 poverty income. 56.8% 51.3% 25.296
� Note: 'Indian'includes American Indian,Eskimo and Aleut
� _,
� Median Family Income in 1980
aza000
521337
� $20000 .............................................. .............................................. ............... ...............
� $16000 -
513722
� 512000 ...............511632............................... ..............................•- •...............
� SS000 �
, $4000 ............... ............... ............_. ............... ............... ...............
� SO
Indian Black White
, St. Paul residents by race
,
ar.n�u.nrv�s�av ff vt�ecx►+�,tt.t►�
, souiCE u&c«�,.eu...0
lB:AprilloDt
131
,
�
Income/Access to Care Objectives/Methods/Bvaluation
Ramsey County Public Health Department ,
o OBJBCTIVS 1: BY DBCB,MBBR 31, 1991, TO DBCRBASB BY 10$ THB ,
NUMBBR OF PBOPLS IN RAI�iSBY COUNTY WHO HAVS NO OR
INADBQUATE ACCBSS TO QUALITY HBALTH CARB.
----- �
Method la: Coordination of community partnerships that
are designed to promote the health of Ramsey �
County residents and strengthen families.
Evaluation la: Data are collected on partnerships developed,
meetings held, and outcomes/system change. �
(Problems 38, 39)
----- �
Method lb: Advocate for increased enrollment in
Children's Health Plan; distribute CHP �
information on all PHN home visits, and ask
clients whether they know neighbors/family/
friends who might be eliqible.
Evaluation lb: Information will be collected on CHP outreach �
and advocacy efforts, and enrollment trends
in Ramsey County will be analyzed. �
Method lc: Work to assure the best possible outcome of �
implementation of the Prepaid Medical
Assistance Program in Ramsey County, to
assure access to medical & dental care for ,
all AFDC and above-age 65 Medical Assistance
recipients in the County, with special
emphasis given to assuring the delivery of �
culturally appropriate services to special,
high risk populations.
Evaluation lc: The Ramsey County Community Human Services ,
Department and the Minnesota Department of
Hwnan Services will devote extensive efforts
to evaluating PMAP. �
Method ld: Advocate for full health coverage for all ,
Ramsey County residents.
Evaluation ld: Information will be collect�d on advocacy �
efforts and outcomes.
132 ,
�
,
Income/Access to Care Objectives/Methods/Bvaluation
, o OBJBCTIVS 2: TO ASSURS THE PROVISION OF HIGH QUALITY,
ACC$SSIBLS HOMB CARB SBRVICBS ON A SLIDING FEB
� SCALE TO ALL IAW-INCOMS ONINSURBD AND
UNDBRINSURBD RAMSBY COUNTY RBSIDBNTS.
(PROBLSI�IS 38, 39)
� -----
Method 2a: To provide Public Health Nurse home visits on
� a sliding fee scale to low-income
underinsured and uninsured Ramsey County
residents.
� Evaluation 2a: Data are collected on sliding fee scale and
no charge home visits. During 1990, out of a
total of 54, 135 home visits, 5,487 ( 10$) were
, provided at no charge to the client, and
3,531 (6.5�) were provided for a reduced fee.
� o OBJBCTIVS 3: TO IMPLBMBNT THB RECOI�II�NDATIONS OF THB HBALTH
PARTNSRSHIP•S 1991 RSPORT TO DSVSLOP STRATBGIBS
TO INCR$ASB THB NUMBBRS OF QUALIFIBD HBALTH CARB
, PROFESSIONALS WHO ARB BILINGQAL AND BI-CQLTURAL
� Method 3a: Seek and obtain qrants from the Public Health
Services Act and other federal programs to
provide financial assistance enablinq
bilinqual and bi- cultural students to enter
, and graduate from nursing and allied health
programs.
� Evaluation 3a: Documentation will be compiled on grant
funding received from federal sources; it is
anticipated that 20 bilingual students in
� Ramsey County will graduate from Associate
Degree in Nursing Proqrams participating in
Health Partnership by December 31, 1995.
� Method 3b: Work with the Bxplorinq Division of the Boy
Scout Indianhead Council to establish a
, Health Careers Exploring Post for minority
youth.
, Evaluation 3b: Each year, a minimum of 20 hiqh school
students of color will participate in monthly
meetings which introduce them to various
health careers and educational programs.
,
, 133
�
�
Income/Access to Care Obiectives/Methods/Bvaluation
rn frm h N inl �
Method 3c: Seek and obtain g a ts o t e at o a
Youth and Community Services Act to develop a
Minority Youth Health Services Corps to �
provide learninq opportunities for students
interested in health care fields, including
structured after-school opportunities for �
volunteer service in community health
settinqs.
Evaluation 3c: Each year a minimum of ten students will i
participate in the program.
Method 3d: Work with local East Metro colleges to �
develop student support and tutoring services
that improve retention rates for bilingual,
bi-cultural students in health degree �
programs.
Evaluation 3d: Documentation will be compiled on grant �
funding secured from public and private
foundation sources to provide stipends for
nursing and allied health program tutors.
Method 3e: Work with local employers and ESL college ,
proqrams to develop on-site continuinq
education in English language proficiency to �
improve the ability of bilinqual workers to
advance in health professions.
Evaluation 3e: By December 31, 1995, employers participating ,
in the Health Partnership will have �
established formal, on-site ESL support
services enabling bilingual employees to ,
improve their lanquage proficiency in
readinq, writing, and speaking English.
Method 3f: Work with the Ramsey County Job Training �
Partnership to develop education and career
counseling services for bilingual and bi-
cultural employees. By June 30, 1992, an ,
informational booklet will be written
outlining various career options in health
care, detailing educational requirements in ,
each field, and outlininq steps necessary to
pursue health career options. The booklet
will be directed to bilingual and bi-cultural �
students, and will be field-tested to
evaluate its effectiveness.
Evaluation 3f: Documentation will be compiled on completion, �
dissemination, and evaluation of booklet.
134 ,
� �- ���3
9
�
Income/Access to Care Obiectives/Methods/Bvaluation
,
Method 3g: Work with the American Refugee Committee to
provide colleqe preparation and language
� training to enable underemployed health care
workers to pursue degree programs for
licensed and registered nursing.
� Evaluation 3g: Private grants will be sought to enable a
minimum of 20 bilingual health care workers
� who are currently underemployed to enter and
graduate from degree programs in nursing and
allied health fields by December 31, 1995.
�
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�
,
Income/Access to Care Objectives/Methods/Evaluation
St. Paul Division of Public Health/Ramse Count Public Health ,
Y Y
Department
o OBJECTIVE 1: TO ASSURB THE PROVISION OF HIGH QUALITY, �
ACCBSSIBLB CLINIC-BASBD AND HOMB CARS SBRVICBS ON
A SLIDING F88 SCALS TO ALL LOW-INCOMB UNINSURBD �
AND UNDBRINSURED RAMSBY COUNTY RESIDENTS.
(PROBLSI�IS 38, 39)
----- �
Method la: Funding is provided to seven Community
Clinics (Face to Face Health and Counseling �
Center, The Family Tree, Health Start,
United Family Practice/Helping Hand Health
Center, Model Cities Health Center, North End �
Health Center, and West Side Community Health
Center) to subsidize the cost of primary and
preventive health care services, including
medical, dental, family planning, and general ,
and targeted health education on a sliding
fee scale to low income, under- and uninsured
Ramsey County residents. ,
Evaluation la: Data are collected on numbers of clients and
services provided as well as financial ,
status. An estimated total of 117,870 visits
were provided to 56,920 patients in 1990.
(City and County funding covers only a
portion of the total costs for this level of ,
service. )
----- �
Method lb: Provide staff and in-kind support to the
Ramsey County Homeless Health Care Project. ,
Evaluation lb: Data are collected on support provided and
client outcomes.
,
,
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,
136 �
,
, Income�Access to Care ObjectivesfMethods/Evaluation
, St. Paul Division of Public Health
� OBJECTIVE 1: TO ASSURE ACCESS TO HIGH QIIALITY, LOW COST,
, COMMUNITY BASED HEALTIi CARE PROVIDED ON A SLIDING
FEE SCALE TO LOW INCOME, UNINSURED AND
UNDERINSURED ST. PAUL RESIDENTS.
, (PROBLEM 38)
, Method la: Referrals to various community resources are
provided to individuals who request information.
� Evaluation la: Referral list is updated bi-annually, as well
as copies of First Call For Help book ordered
annually.
, ----
Method lb: Outreach activities are performed through various
, programs including Loaves and Fishes, Children' s
Health Plan Outreach and Division programs to
connect individuals needing assistance to
� available health and social service resources .
Eligible individuals are also signed up for
Children' s Health Plan and Medical Assistance.
� Evaluation lb: Data are collected on the number of people
contacted and the referrals/assistance
provided.
� ----
, Method lc: Will evaluate the feasibility of implementing a
program to assess and evaluate health and
immunization needs of adults and children
requesting immunization services at the Division
� of Public Health.
Evaluation lc: Data will be collected during a pilot project
, to identify the number of people assessed,
needs identified, and referrals made.
� Method ld: Continue to advocate for federal, state and local
programs which will ensure health care for all
, Ramsey County residents .
�
` 137
,
IncomefAccess to Care ObjectivesfMethodsfEvaluation �
Evaluation ld: Efforts are evaluated based on the ,
development of new programs to ensure access
to health care.
---- �
• OBJECTIVE 2: TO INCREASE THE NUMBER OF ELIGIBLE INDIVIDIIALS
ENROLLED IN MEDICAL ASSISTANCE, CHILDREN'S HEALTH �
PLAN AND OTHER LOW COST MEDICAL PROGRAMS.
(PROBLEMS 38)
Method 2a: A re resentative from the Ramsey County Human �
P
Services Department conducts outreach in the
Public Health Center lobby twice a month to sign �
eligible individuals up for various programs and
make referrals to other resources.
Evaluation 2a: Data can be collected on persons receiving ,
information and application assistance.
---- ,
Method 2b: Through outreach efforts at the Frogtown Loaves
and Fishes site, each Monday evening individuals ,
are signed up for Children' s Health Plan and
referred for enrollment in Medical Assistance when
eligible. Referrals are also made to other
resources. �
Evaluation 2b: Data is collected on the number of
individuals receiving information and those �
who are referred or enrolled on various
health plans.
---- ,
Method 2c: Outreach to increase enrollment on Children' s
Health Plan of eligible individuals is completed ,
through various efforts with community groups,
community agencies and schools.
Evaluation 2c: Data is collected on the number of people ,
provided with information on available plans
and programs. �
,
,
138 �
,
,
Income/Access to Care Inventory
�
The listing of community providers included in the various Inventory
, sections of this Plan each provide access to a portion of the health
services utilized by residents of Ramsey County.
�
,
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,
,
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,
,
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� 139
,
,
Blderly Problems/Goals
,
PROBLSM 40: High rate of inability for self-care among persons 85+,
the fastest qrowinq age cohort in the population;
� inability/difficulty of elderly to perform Activities of
Daily Living (ADLs) **
, GOAL 40: To increase to a maximum the ability of the elderly to
perform ADLs and to assure access to needed services for
this population
, PROBLBK 41: Hi h rate of need for careqiver support for homebound
9
elderly **
� GOAL 41: To assure caregiver support services for persons caring
for homebound elderly
,
,
� ** Identified as one of thirteen Highest Priority Problems by St.
Paul-Ramsey County Community Health Services Advisory Committee
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, 140
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Blderly Rev Data
1. According to the Minnesota Department of Human Services Caregiver
,
Support Project, over 85� of the care given to elderly persons in
Minnesota is provided by informal caregivers, i.e. family, �
friends, neighbors, etc.
2. According to the Lutheran Social Services Share-a-Home Program, ,
122 home sharing arrangements have been developed between older/
disabled persons and live-in persons in the East Metro Area since
1988; 59� of these have been in St. Paul, 39� in Suburban Ramsey ,
County. There are currently 37 such arrangements involving 79
individuals. Studies have shown that over 70� of the elderly/
disabled who participate in this program would be at risk of
nursing home placement without their live-in arrangement. �
3. According to the Interagency Board for Quality Assurance
(Minnesota Departments of Human Services, Health, State Planning ,
and Housing Finance Agency) , the population of the State of
Minnesota is projected to grow from 4,370,888 persons to 4,755,787
persons between 1990 and 2010, an 8.8� increase. The population ,
between 65-74 years is projected to grow from 295,963 to 343,253,
a 16� increase. The population between 75-84 years is projected
to grow from 184,432 to 219,633, a 19$ increase. The population
age 85 and over is projected to increase from 68,544 to 112,472, a �
44$ increase.
4. As demonstrated in the table on the following page, the Elderly ,
Age Dependency Ratio for Ramsey County is the highest among the
seven metropolitan area counties, just below the statewide
average, while this ratio for the City of St. Paul is well above
the statewide average. ,
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141 �
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Blderly Rev Data
� CHILD AND BLDBRLY AG8 DSPBNDBNCY RATIOS
SSVSN MSTRO COUNTIBS, ST. PAUL AND I�INNBSOTA: 1980 AND 1988
� ----
Child Aqe Blderly Aqe Total Age
, Dependency Ratio Dependency Ratio Dependency Ratio
1980 1988 1980 1988 1980 1988
, COUNTY
STATB 35.2 34.7 18.0 19.0 53.3 53.7
� Anoka 43.0 39.6 6.2 5.6 49.2 45.2
, Carver 40.0 37.5 13.7 11.6 53.7 49. 1
Dakota 41.5 38.4 8.9 7.8 50.4 46.3
, Hennepin 28.4 26.5 15.6 16.9 44 .0 43.3
RAMSBY 30.9 30.1 17.2 18.9 48.1 49.0
, ST. PAUL 29.7 29.1 22.9 25.3 52.6 54.4
, Scott 44 .4 44.0 11.5 9.9 56.0 53.9
Washington 42.3 40.8 8.7 7.9 51. 1 48.7
,
� CHILD AGB DBPBNDBNCY RATIO = # people < 15 years old
----------------------- % 100
� # people 15-64 years old
REPRESBNTS PROPORTION OF CHILDREN BBLOW AGB 15 IN POPULATION RBLATIVB
TO "PRODUCTIVB" ADULT POPULATION BBTWBBN AGBS 5-64.
i
�
BLDBRLY AGB DEPENDBNCY RATIO = � people 65+ years old
� ---------------------- X 100
� people 15-64 years old
REPRESENTS PROPORTION OF BLDBRLY POPULATION ABOVE AGB 65 IN POPULATION
� RELATIVB TO "PRODUCTIVS" ADULT POPULATION BBTWSBN AGBS 15-64.
, 142
,
�
Elderly Rey Data
�
5. According to the Interagency Board for Quality Assurance, in the
metropolitan area, the 85+ age cohort is projec*pd to increase by �
29. 1� between 1990-2000, by 33.9� between 2000-2010, and by a
total of 72.9� between 1990-2010; this twenty-year increase is
significantly greater than that anticipated for the state as a
whole (64 . 1� for the twenty year period. ) ,
6. As demonstrated in the following graphic from the Interagency
Board for Quality Assurance, Minnesota institutionalizes a �
significantly greater proportion of its elderly residents than the
U.S. average.
,
LTC INSTITUTIONAL CARE EXPENDITURES ,
By percent, Minnesota vs. Oregon
�
��.������e,,.� _ �
r�s
IMIIIU11M�1
Olf
01��r ,
Of
p��r
40f
Minnesote Oregon
,
� ' PERCENT OF ELDERS IN INSTITUTIONAL �
Ape 65•
I
w. ` �
r.r
�� �
& �
s � .
f
N >Ldr ��
.:S>d�R.,.
. � '
_ :...�..y:'s'::,:'
• — �� — �
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. Orr«•u �u.�. �a.w
Ud1 M�h YM�Nw
�
143 �
,
�
Blderlv Rev Data
�
7. As demonstrated in the following graphic from the Wilder
Foundation, functional problems among the elderly increase
tsignificantly with increasing age.
,
�
FUNCTIONAL PROBLEMS OF ELDERLY PERSONS
� % with difficulties, by age group
Percent
� 25
21
20 k� ° 18
� �
�.
��:J: 1� � t�
��J .,�,-Y;�". :
r��. ���,� �•�z�
, '�zs. . -
�w �:
' �Q `7ss�.: �� � r
1O nw+`s', � :,R'� �Y
�,-�;;: !��i � .,�
, ��,.
% � :�
� x .d
��i
5 3 3 3 � 3 "��
� �� �
r � ,, :� � ...
Personal care Preparin9 frteals light housework Getting outside
� � qye 60-�4 Aqe �5• '�"�' Aqe 85+
Wilder Foundation, 1990 (1989 data)
85• data for Greater Mn. only
,
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� 144
,
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Elderly Ob-iectives/Methods/Evaluation
Ramse Count Public Health De rtm n �
y y pa e t
o OBJBCTIVS 1: TO DBTBRMINB BLIGIBILITY FOR WAIVSRBD SBRVICB �
PROGRAMS AND DBVSLOP AND IMPLSMBNT APPROPRIATB
CARB PLANS FOR 100$ OF BLIGIBLB COUNTY RESIDBNTS
IN ORDBR TO MAINTAIN INDIVIDUALS IN THE LBAST ,
RESTRICTIVB BNVIROHI�IBNT. TARGBT POPULATIONS ARE
COUNTY RESIDBNTS WHO HAVS BEBN ADMITTED, OR ARE
AT RISR FOR NURSING HOMB PLACSMENT; COUNTY �
MEDICAL ASSISTANCB RECIPIBNTS AT RISR FOR
UNNBCBSSARY HOSPITALIZATION; AND COUNTY 1rI.A.
RBCIPIBNTS REC$IVING BXPBNSIVB ($800+/1rIONTH) HOI�
CARB SBRVICBS. �
(PROBLBI�I 4 0)
• ----- �
Method la. Screening for eligibility to the following
waivered service programs: Alternative Care �
Grants (ACG) , Community Alternatives for
Disabled Individuals (CADI) , Community
Alternatives for Care (CAC) , and Health Care
Cap Assessments (HCCA) ; development and �
monitoring of care plans funded through these
programs.
Evaluation la: Data are maintained on eligible clients, �
screenings, services arranged for and
delivered, and outcomes of care. Two
thousand clients are projected to be served �
annually.
----- �
o OBJECTIVB 2: TO MAINTAIN IN THBIR HOMB� 100$ OF REFBRRED ,
BLDBRLY PBRSONS ACCBPTBD FOR SBRVIC$ WHO CAN B8
APPROPRIATBLY MAINTAINBD IN THBIR HO1� AND WISH
TO REI�IAIN HOMS IN ORDBR TO AVOID UNNBCBSSARY
INSTITUTIONILIZATION. �
(PROBLBI�I 4 0)
----- �
Method 2a: Provision of nursing assessment, home health
aide/homemaker services, skilled nursing �
care, and case management/service
coordination.
�
145 ,
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Elderly Oblectives/Methods/Bvaluation
,
Evaluation 2a: Data are collected on numbers of clients and
� home visits, services provided, and outcomes
of service. Thirty thousand annual visits
provided to the ill, disabled, elderly and
mentally impaired to maintain or improve
� health status.
� Method 2b: Short-term, short hour in-home health
services assured for individuals who need
such nursing care.
� Evaluation 2b: Data are collected on number of clients
served and services provided.
� -----
� Method 2c: Nursing assessment, home health aide/
homemaker services, skilled nursing care,
case management/service coordination that
supports clients living at home in the
, Highland Park and North End/South Como
neighborhoods of St. Paul. Target population
is persons age 65 and over residing in the
� Highland Park and North End/South Como
neighborhoods.
, Evaluation 2c: Data are collected on nwabers of persons
served and services provided. One
hundred clients are projected to be
served in the two Block Nurse Program
� neighborhoods annually.
� o OBJECTIVE 3: BY D$CBMBBR 31, 1993 TO DBVSLOP AND IMPLSMBNT A
SBT OF ALTBRNATIVB STRATSGISS TO ADDRBSS THE
, HEALTa NSBDS OF THB BLDBRLY IN RAI�SBY COUNTY.
(PROBLSI�IS 4 0, 41)
� Method 3a: Coordination of community partnerships that
are designed to promote the health of Ramsey
� County residents and strengthen families.
�
� 146
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Elderly Ob7ectives/l�ethods/Bvaluation
3 • ,
Evaluation a. Data are collected on partnerships developed,
meetings held, and outcomes/system change. �
Method 3b: Implement a planning team to include �
community clinics, high rise and Public
Housing staff, other community-based
providers, and Ramsey County Community Human �
Services Department Elderly Services staff to
analyze and implement as appropriate a series
of alternative service delivery and planning
strategies which might include: �
1. Provision of Health Fairs every 6 months at
high rises using a body systems education �
approach, with one presentation per month
covering care of a different part of body,
i.e. eyes, ears, feet, skin care, as well as �
on specific topics including blood pressure
medication management, nutrition, etc. ;
2. Development of regularly health promotion/ ,
education presentations at high rises on
mental health, depression, drugs & alcohol;
3. Obtaining a mobile van to provide �
neighborhood-based mini-clinics including lab
services, immunizations, etc. ;
4. Going to congregate dining sites and provide �
BP screening, foot care, general/targeted
health education; �
5. Developinq an inservice agenda in
collaboration with other agencies (Wilder, �
Red Cross, etc. ) to inservice private agency
homemakers to identify and report potential
health problems, as well as how to access
health services; ,
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147 ,
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Blderlv Obiectives/Methods/Bvaluation
, 6. En ra in and fosterin care iver su ort
cou g g g g pp
programs in community; referring caregivers
1 into support programs; encouraging
development of respite care for foster care
providers; exploring funding for an Adult
� Companions Proqram; and developing &
coordinating volunteer networks; and
� 7. Providing increased consultation and training
of public housing staff to add to their
abilities to do simple health screening/
identification of health problems which may
� require professional attention & care.
8. Continue to build a community-based approach
� and community commitment to delivering long-
term care services for elderly persons in
their homes.
� Evaluation 3b: Information will be collected and reports
developed on outcomes of planning and program
implementation efforts.
, -----
� Method 3c: Investigate the potential for Ramsey County
to be a Senior Agenda for Independent Living
(SAIL) demonstration County to implement the
SAIL objectives to:
� 1. Implement a broadened and flexible system of
preadmission screeninq, information and
' referral, early intervention and assessments;
2. Develop additional residential and community
, alternatives such as adult foster care,
family adult day care, assisted living and
congregate housinq services; and
, 3. Expand caregiver support efforts, volunteer
services and community care manager programs.
� Evaluation 3c: Documentation of outcome of analysis of a
potential Ramsey County SAIL proposal, and
outcome of County proposal if submitted.
�
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Elderly Objectives�Methodsf8valuation �
St. Paul Division of Public Health ,
• OBJECTIVE 1: TO ASSURE ACCESS TO HIGH QUALITY, LOA COST,
COMMUNITY BASED HEALTH CARE PROVIDED ON A SLIDING �
FEE SCALE TO LOW INCOME, UNINSURED AND
DNDERINSURED ST. PAiJL'S ELDERLY RESIDENTS.
(PROBLEM 40) ____ �
Method la: Funding is provided to four community clinics �
(Helping Hand Health Center, Model Cities Health
Center, North End Medical Center, and West Side
Community Health Center) who offer services to the
elderly community. �
Evaluation la: Data are collected to indicate the number of
individuals served and the type of service �
received through the use of these funds.
Method lb: To rovide flu shots and referrals to other �
P
locations for flu shots to St. Paul ' s high risk
and elderly residents for a low cost or on a ,
donation basis.
Evaluation lb: Data are collected on the number of �
individuals receiving flu shots. Data on the
prevalence of influenza can also be reviewed.
In 1990 1,689 individuals were provided with
flu shots through DPH programs. �
Method lc: Public Health Housing Program staff make referrals �
to appropriate agencies for any elderly persons
they encounter and identify as needing assistance ,
in their daily living activities.
Evaluation lc: Follow up is completed to ensure that
appropriate agencies become involved in cases �
as necessary.
Method ld: Division of Public Health staff work closel with �
Y
the Mayoral directed Advisory Committee on Aging
to identify existing problems in the aging �
community and make recommendations for alleviating
and avoiding problems.
�
149 ,
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� Elderly Ob�,ectivesjMethodsfEvaluation
� Evaluation ld: Will monitor the recommendations made and
whether or not they are accepted and acted
upon.
� ----
Method le: Continue to assist in the health maintenance of
� the aging population through promoting physical
fitness, safety, and mental health through
education and activities, in order to increase
their ability to maintain performing ADLs.
� Evaluation le: Data is collected on the number of elderly
individuals who participate in various
, programs and educational sessions .
�
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Blderly Inventorv
Home Care Providers: �
o A Chance to Grow, 5034 Oliver Ave. N. , Minneapolis
o Abbott-Northwestern Home Care, 5775 Wayzata Blvd. , St. Louis Park
o All Temporaries/A.T. Home Care, 2110 Nicollet Ave. S. , Minneapolis �
o Allied Health Alternatives, 4915 W. 35th St. St. Louis Park
o Becklund Home Health Care, 8421 Wayzata Blvd. , Golden Valley
o Block Nurse Programs (Highland Park, North End-Como & St. Anthony �
Park neighborhoods of St. Paul)
o Care Plus Home Health Agency, 1115 S. Second Avenue, Minneapolis
o CareVan Home Care, 4550 W. 77th St. , Edina �
o Carefinders, Inc. , 18121 Pandora Blvd. , Prior Lake
o Caremark Homecare, 1355 Mendota Heights Road, Mendota Heights
o CommonHealth Clinic, 13961 N. 60th Street, Stillwater
o Critical Care America, 811 W. 106th Street, Bloomington �
o Ebenezer Community Services, 110 18th Street, Minneapolis
o Equity Services of St. Paul, 811-1/2 University Ave. St. Paul
o Favorite Nurses, 2550 University Ave, St. Paul �
o First Call Home Health Care, 730 Mount Curve Blvd. St. Paul
o Group Health Continuing Care/Hospice, 2829 University Avenue SE,
Minneapolis �
o Health Counseling Home Care, 6465 Wayzata Blvd. , Minneapolis
o Health One Home Care, 3030 Centre Point Drive, Roseville
o Health Pro Nursing Service, Inc. , 8707 Grospoint Avenue South,
Cottage Grove �
o HealthEast, 559 Capitol Blvd. St. Paul
o Hospital Home Care, 2450 26th Avenue South, Minneapolis
o In Home Services, 3433 Broadway Street NE, Minneapolis ,
o Integrated, 640 Jackson, St. Paul
o Kimberly Quality Care Nursing Services, 2550 University Avenue
West, St. Paul
o Lakeview Hospital Homecare, 919 West Anderson Street, Stillwater ,
o Living at Home (Macalester-Groveland & West 7th Street
neighborhoods of St. Paul)
o Medical Personnel Pool, 3400 W. 66th Street, Edina �
o Metro Home Health Care, Inc. , 1885 University Ave. , St. Paul
o Metropolitan Visiting Nurse Association, 250 S. 4th Street,
Minneapolis �
o Moonlight Nursing Care, Inc. , 1313 5th Street SE, Minneapolis
o Nightinqales, 1433 Franklin Avenue, Minneapolis
o Nursing Care Service Professionals, Inc. , 301 W. Burnsville
Parkway, Burnsville �
o Olsten Health Care Services, 2550 University Ave. W. , St. Paul
o Optional Care Systems, Inc. , 2550 University Ave. W. , St. Paul
o ParaNatal Care Services, 1401 W. 76th Street, Minneapolis �
o Presbyterian Home Care, 1919 W. County Road D. , Roseville
o Quantam Health Resources, 12268 Nicollet Avenue S. Burnsville
o REM Health, Inc. , 3101 W. 69th Street, Edina �
o St. Paul Rehabilitation Center, 319 Eagle Street, St. Paul
o Special Children's Home Care, 9287 Wedgewood Drive, Woodbury
o Staff Builders Home Health Care, 12 South 6th Street, Minneapolis
o TLC Nursing Services of Roseville, 1255 W, Larpenteur, Roseville �
151 �
�
�
Blderlv Inventory
� Home Care Providers (cont. ) :
o U of M Hospital & Clinic Home Health Care, flarvard at E. River
� Road, Minneapolis
o Upjohn Healthcare Services, 2657 University Ave. , St. Paul
o Walker Home Services, 3737 Bryant Avenue South, Minneapolis
o Wilder Home Services, 919 Lafond Avenue, St. Paul
, Senior Centers:
o Baker Community Center, 209 West Page, St. Paul
� o Capitol Community Services, 1021 Marion Street, St. Paul
o CLUES, 220 South Robert Street, St. Paul
o District 622 Senior Citizen Program-North St. Paul-Oakdale-
Maplewood, 1945 Manton Street, Maplewood
, o Hallie Q. Brown Community Center, 100 North Oxford, St. Paul
o Jewish Community Center of St. Paul, 1375 St. Paul Avenue, St. Paul
o Lyngblosten Community Senior Center, 1298 N. Pascal, St. Paul
1 o Merriam Park Community Center, 200 St. Anthony, St. Paul
o Merrick Community Services, 715 Edgerton, St. Paul
o Neighborhood House Association, 179 East Robie Street, St. Paul
� o Roseville Area Senior Program, 1910 W. County Road B. , Roseville
o West Seventh Community Center, 265 Oneida Street, St. Paul
o West St. Paul Area Senior Center, 1037 Bidwell, St. Paul
o White Bear Area Senior Program, 2399 Cedar Avenue, White Bear Lake
� Service Coordination/Advocacy/Misc. Services:
o Catholic Charities, 215 Old 6th Street, St. Paul
� o Conservators Plus, 1563 Selby Avenue, St. Paul
o Family Service of Greater St. Paul, 166 E. 4th Street, St. Paul
o Gray Panthers, 3255 Hennepin Avenue, Minneapolis
o Lutheran Social Service (Share a Home) , 1299 Arcade Street, St.
I Paul
o Senior Chemical Dependency Program, 570 Capitol Blvd. , St. Paul
o Senior Companion Program, 3225 Lyndale Avenue South, Minneapolis
� o Senior Health Care Center, St. Paul-Ramsey Medical Center, 640
Jackson, St. Paul
o Senior Law Project, 46 E. 4th Street, St. Paul
�
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�
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�
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Lifestyle/Cancer Problems/Goals
� -----
PROBLBM 42: Increasinq prevalence of chronic diseases due to
� lifestyle choices **
GOAL 42: To eliminate lifestyle choices which have been
, demonstrated to cause chronic disease, and to assure
services to address chronic diseases
� PROBLEM 43: Hi h incidence of mali nant neo lasm deaths includin
9 9 P . 9
increasing rate of lung cancer, which is the leading
� cause of cancer-related death in Minnesota, and
increasing incidence rates of new cancers of the breast,
lung, cervix and the colon/rectum
� GOAL 43: To reduce the incidence of malignant neoplasm deaths
�
** Identified as one of thirteen Highest Priority Problems by St.
� Paul-Ramsey County Community Health Services Advisory Committee
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� 153
�
�
Lifestyle/Cancer Rey Data
1 m w r h 1 in f �
1. Malignant neop as s e e t e ead g cause o death in 1988 in
Ramsey County among individuals between the ages of 25-74 years,
and the second leading cause of death among individuals 75 years �
of age and older.
2. Malignant neoplasms accounted for 930 (23�) out of 4,055 total �
deaths among persons of all ages in Ramsey County in 1988.
Malignant neoplasms accounted for 45 (23$) out of 198 total deaths
among persons between the ages of 25-44 years, out 217 (38$) out �
of 579 total deaths among persons between the ages of 45-64 years,
and 287 (35�) out of 828 deaths among persons between the ages of
65-74 years.
3. Malignant neoplasms as a cause of death resulted in the highest �
number of Years of Potential Productive Life Lost in Minnesota in
1988, accounting for over 25,000 YPPLL in that year. �
4 . Lung cancer death rates in Minnesota have continued to rise,
accounting for 1,900 deaths statewide in 1990. �
5. The highest rates for new cancer cases in Minnesota in 1990 were:
female breast (2,600 new cases) ; colon and rectal (2,600 new
cases ) ; lung (2, 100 new cases) ; and prostate (2,000 new cases. ) �
6. As demonstrated in the graphics on the following page, cardio-
vascular disease was the number one cause of death among Ramsey �
County residents during the period 1980-1988, accounting for
almost 1,800 deaths, followed by malignant neoplasms, which
accounted for almost 1,000 deaths during this period. Digestive ,
cancers accounted for the majority of malignant neoplasm deaths
during this period, followed by respiratory and genital cancers.
�
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154 �
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Lifestvle/Cancer Rey Data
�
� NUMBER OF DEATHS BY SELECTED CAUSES
RAMSEY COUNTY RESIDENTS, 1980-1988
Numb�r of d�atha
� �
: . , ,
. , , , . .
t,eoo . .
........... .:.......... ..............,•••---- -...,.......... ...................;................
Cardiovascular
� �'eoo . , ` ....... .......... ........... ...........
, � .
� , . ,
� . . .
. . , .
�,wo ...............;.................................................:...............
...............:.................................. . .
. . ,
. . ,
� ' . � ........... ........... .......... .....•-�--- •--....--•-
, . , .
. . .
�,zoo • . , •
°.............:............................•••..F.. ..;... ..;...
`..........�...........5. i.
��p ...............:. �j9�lallt ...............---.........---.:.------.....---�-..............
�190p1�m8
� , ' � -.°°.....
.
.
800 . . , ..° -.°°---°
. , , . .
. , , . , .
a00 ' . , . , .
•••-•..........:.................................�...............a...............i................................y...............
� ............._i..........._...:..._... 1. � �.._..._. ........._...i•--'•••••--....
• .....:... ...:...
� �����
dt G1�1@�VIOIBflCB
Zpp ` ' ........,............................._ -••••••••••-
� O . . �
1980 1981 1982 1983 1984 1986 1986 1987 19BB
Year of death
�
� CANCER DEATHS O F RAMSEY COUNTY RESIDENTS,1980-1988
Typ�ot Canc�r
� al other
.............'"."""............""".....p......"'...........:..""'.............:.....................}....................
• :
� � .......... ................ ................
� . .
Unnary ; : : :
Leukemia
� .................:................. .................<...................;.................. ..._.......•••-
Breast
_ . _ . _ ,_ ,
� Genital
Respira�y
r ....................:....................4................_...:....................:....................�...._............
��
� 096 5% 1096 15% 2096 2596 30%
P�rc�nt of Canc�r D�aths
� �.wnsiwsti�.riw
r�: ����r��
155
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,
Lifestyle/Cancer Obiectives/Methods/Evaluation
Ramsey County Public Health Department �
o OBJSCTIVS 1: BY DBCEMBBR 31, 1995 TO DBVSLOP AND IMPLEIrIENT A
SET OF ALTBRNATIVS STRATBGIBS TO ADDRSSS �
LIFBSTYLE ISSUES IN ORDBR TO RSDUCS THE INCIDBNCE
OF CANCBR AND OTHER CHRONIC DISBAS$S IN RAMSBY
COUNTY RESIDBNTS. �
(PROBLEMS 42, 43)
Method la: Coordination of community partnerships that �
are designed to promote the health of Ramsey
County residents and strengthen families.
Evaluation la: Data are collected on partnerships developed, �
meetings held, and outcomes/system change.
----- �
Method lb: Implement a planning team to include �
community clinics, other community-based
providers, and Ramsey County Community Human
Services Department staff to analyze and
implement as appropriate a series of service �
delivery and planning strategies which might
include:
1. Advocate and study the need for development �
of additional resources to provide low-cost
cervical and breast cancer detection & �
screening, and education regarding the need
for mammograms, pap smears, proctos & checks
for testicular cancer; build education &
screenings into high rise/Public Housing �
health services.
2. Teach need for pap smears, etc. during PHN �
home visits.
3. Develop Women's Health Days at various sites
across County to offer pap smears, �
mammography, education & referral, etc.
4. Targeted and appropriate education & outreach �
to communities of color, other cultures.
5. Look into developing clinics at Public �
Housing sites for education, well baby care,
female health needs, etc.
�
156 r
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Lifestyle/Cancer Obiectives/Methods/Bvaluation
, 6. C 11 b r w'
o a o ate ith Nutrition, EFNEP, community
clinics, Meals on Wheels on cholesterol/
� cardiovascular risk appraisal/education
program.
� 7. Identify and work to eliminate environmental
threats to the public's health.
� 8. Pursue Alcohol and Other Drug and Office of
Substance Abuse Prevention grants to develop
interventions to decrease drug, alcohol &
tobacco use.
� 9. Provide hypertension/BP screening in
conjunction with education regarding
1 lifestyle change -- identify targeted
screening services for specific high risk
populations.
� 10. Explore need for worksite wellness program:
look at existing programs & gaps in types of
businesses that cannot/do not access, missing
� Public Health pieces of curricula; work with
another County department to pilot a County
employee worksite wellness program.
, Evaluation lb: Information will be collected on planning
efforts and outcomes.
�
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, 157
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Lifestyle,/Cancer Objectives/Methods/Evaluation i
St. Paul Division of Public Health �
• OBJECTIVE l: TO REDUCE BY 5$ OF 1988 LEVELS, THE NII1�iBER OF
INDIVIDDALS PLACED AT HIGH RISK OF CANCER DIIE TO �
LIFESTYLE CHOICES, DECEMBER 31, 1995.
(PROBLEMS 42 AND 43)
---- �
Method 1: Undertake a number of efforts, both new and
renewed, which could have a potential impact on �
decreasing unhealthy lifestyle choices which may
increase future cancer rates .
a: Initiate efforts to work with the Cancer Society, '
the Lung Association and the Heart Association to
ensure that printed materials are translated into �
various non-English languages, and perhaps develop
videotapes.
b: Investigate the support and feasibility to train �
ethnic representatives to present smoking
cessation courses in the community.
c: Work with and coordinate D-Day efforts focused on �
smoking cessation.
d: Serve as facilitator for Smoking Cessation courses �
at City worksites and businesses within St. Paul.
e: Begin to work with the American .Lung Association �
to establish a volunteer speakers bureau regarding
tobacco use to offer presentations at schools and
to community groups. �
f: Work with community clinics and WIC staff to
identify and train staff on how smoking cessation
can most effectively be presented to clients in a �
short time span.
g: Provide educational information to clients and the �
community through various means as determined to
be feasible, including bulletin boards, printed
materials and videos. �
Evaluation la-g: Data on lifestyle choices and cancer rates
can be evaluated to determine increases or
decreases. Additionally, data can be �
collected on the number of individuals
provided with education through the above
efforts . �
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� LifestylefCancer ObjectivesfMethodsfEvaluation
� Method lh: Continue to work with the Hepatitis B Coalition to
prevent liver cancer through limiting carriers of
Hepatitis B.
� Evaluation lh: Data will be collected on the various
activities of the Coalition, and the number
of people reached through their efforts .
� Method 1 ' : Referrals to other communit resources are made to
J Y
individuals who need additional information,
� screening or treatment which is not provided
directly by the St. Paul Division of Public
Health.
� Evaluation lj : Referral lists are updated regularly to
ensure that correct information is being
� given. Data could be collected to indicate
the type and volume of referrals made.
� • OBJECTIVE 2: TO ENCOIIRAGE EARLY DETECTION SCREENING FOR
CERVICAL AND BREAST CANCER TO PERSONS WHO ARE LOW
� INCOME, UNDERINSIIRED, iJNINSURED OR WITHIN HIGH
RISK COMMUNITIES OF COLOR.
(PROBLEMS 42 AND 43)
� ----
Method 2a: Will identify persons who are low income,
� underinsured, uninsured or within high risk
communities of color from within the existing
Title X caseload who would be eligible to receive
, grant related screening for cervical and breast
cancer. Performance of this activity is based on
pending funding.
� Evaluation 2a: Data can be collected to identify the number
of clients served through these efforts, and
the outcomes.
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� Method 2b: Will increase availability of screening services
to other eligible populations . Performance of
this activity is based on pending funding.
� Evaluation 2b: Data can be collected to identify the number
of persons screened.
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Lifestyle�Cancer Objective�MethodsfEvaluation �
Method 2c: In cooperation with the Metro Health Educators �
group, develop public service announcements (PSAs)
regarding breast and testicular exams .
Evaluation 2c: Data can be collected on the number of PSAs �
developed, and the estimated audience
reached.
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Method 2d: Referrals to other community resources are made to
individuals who need additional information, �
screening or treatment which is not provided
directly by the St. Paul Division of Public
Health. �
Evaluation 2d: Referral lists are updated regularly to
ensure that correct information is being �
given. Data could be collected to indicate
the type and volume of referrals made.
---- �
• OBJECTIVE 3: TO CONTINOE TO INFORM INDIVIDUALS AND LEAD TO
REDIICTION OF NEGATIVE LIFESTYLE CHOICES WHICH �
INFLIIENCE HEALTH STATUS THROUGH DECEMBER 31, 1995.
Method 3a: Continue to rovide, and expand education and �
P
information on heart disease to community groups .
Evaluation 3a: Data are collected on the number of ,
individuals provided with education and
information. �
Method 3b: Pursue the development of community based �
involvements and activities related to chronic
disease and lifestyle choices through working with
community leaders and agencies for long-term �
support and involvement.
Evaluation 3b: Data and information will be kept on �
associations which are established, and the
experiences and progress of those activities.
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� LifestylefCancer ObjectivesjMethods/Evaluation
� Method 3c: Evaluate the role and focus of the DPH
Cardiovascular Disease Task Force and explore
possibilities for future activities.
, Evaluation 3c: The role and activities of the group will be
evaluated after they have been determined.
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Lifestyle/Cancer Inventory
- E r Ar 2265 �
o American Cancer Society Ramsey County and ast Met o ea,
Como Avenue, St. Paul ,
o American Diabetes Association, MN Affiliate, 3005 Ottawa Avenue S. ,
St. Louis Park
o American Heart Association, MN Affiliate, 4701 W. 77th Street,
Minneapolis �
o American Lung Association of Ramsey County, 480 Concord Avenue, St.
Paul
o Cancer Information Line, 3316 W. 66th Street, Minneapolis �
o Community Clinics:
-Face to Face, 642 E. 7th Street, St. Paul
-Family Tree, 1619 Dayton Avenue, St. Paul
-Model Cities, 430 N. Dale Street, St. Paul �
-North End, 135 Manitoba Street, St. Paul
-United Family Practice/Helping Hand, 545 W. 7th Street, St. Paul
-West Side, 153 Concord Street, St. Paul �
o Health Start, 640 Jackson Street, St. Paul
o International Diabetes Center, 4959 Excelsior Boulevard, St. Louis
Park �
o Minnesota Dietetic Association, 1821 University Avenue, Suite 280,
St. Paul
o Minnesota Food, Education and Resource Center, 708 3rd Street
South, Suite 300, Minneapolis �
o Minnesota Nutrition Council, Inc.
o Twin Cities District Dietetic Association, 1821 University Avenue
W. , Suite 280, St. Paul �
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Nutrition Problems/Goals
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PROBLEM 44: Prevalence of chronic illness/disabilities associated
, with poor nutrition
PROBLEM 45: Prevalence of chronic disease associated with obesity
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PROBLEM 46: Inadequate quality of food, leading to prevalence of
, chronic disease and malnutrition
PROBLEM 47: Dependence of populations/individuals on food shelves/
commodities (poor quality, uneven supply) , leading to
� prevalence of chronic disease and malnutrition; high
prevalence of residents of public housing skipping meals
and relying on food shelves/commodities for food
� GOAL 44-47: To assure ade f
quate ood supplies, foster appropriate food
choices, and reduce the incidence of obesity among all
� residents of Ramsey County
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Nutrition Rey Data
1. Accordin to MDH 2O.4� of Ramse Count adults were at risk for �
9 . Y Y
obesity in 1988.
2. According to the Wilder Foundation St. Paul PHA Familv Survev ,
published in June, 1990:
About two in ten PHA family households received free �
commodities in the past 3 months, and about one in ten
used a food shelf. Smaller proportions received emer- �
gency food from friends or relatives (5�) or ate at a
hot meals program ( 1�) . In addition, about one in ten
households skipped meals in the past three months be-
cause they lacked money or food. These proportions �
are the same at all four PHA locations.
3. According to the 1990 Saint Paul Overniqht Shelter Board Report �
to the Mayor and City Council, 17$ of homeless persons in St.
Paul reported using a food shelf within the past month; one
mother in eight "reported that their children had missed a meal �
in the prior month because there wasn't enough money for food";
and "parents reported the main needs of children as
clothing/shoes, food, counseling, and daycare. " �
4. Heart disease is a leading cause of death in the state, followed
by cancer, according to Minnesota Center for Health Statistics, �
MDH, July 1988.
5. National Institutes of Health, 1984, reports that almost half of
the adult women in Minnesota over age 45 are affected by �
osteoporosis.
6. According to MDH, 21.5$ of all Ramsey County adults were at risk �
for hypertension in 1988.
7. The Minnesota State WIC Proqram estimates that statewide 74� of �
those eligible for WIC are being served.
8. The following data are taken from the "Hunger Hurts" report of
the Urban Coalition and the Minnesota Food Bank Network: �
o Based on a statewide food shelf user survey in 1990, only 61�
of households received food stamps, while nearly all food �
shelf users appeared eligible.
o According to the same survey, the most common reason for not �
participating in the food stamp program was that people didn't
think they were eligible.
o Half of the households using food shelves spent more than 50� �
of their income on housing costs.
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Nutrition Rey Data
� - h 1 in f h lv 65
o Nearly two thirds of house o ds us g ood s e es ( �)
include children under 18 years of age.
�
The following data are taken from the St. Paul Ramsey County Nutrition
� Program 1990 Annual Report:
o The Division provided 29,353 nutrition screenings, assessment
, and surveillance services in 1990 (25, 172 in WIC and 4, 181 in
Nutrition. )
o A total of 15,640 persons received information/education
� through food distribution sites or health information sites in
1990.
� o A total of 20,664 referrals were made by the Nutrition Program
in 1990. Of this total, the following specific referrals were
made:
� -AFDC 771
-Children's Health Plan 1440
-Commodity Foods 432
-Emergency Food Service 756
� -Food Stamps 1208
-First Call for Help 661
-Mothers & Children (MAC� 2828
� -WIC 584
9. According to the Homegrown Hunger, the Minnesota Food Education &
Resource Center report updated in January, 1990, 54$ of those
� surveyed said that adults in their household skipped meals in the
past month because there wasn't enough money for food. Children
missed meals in 23$ of the families with children.
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Nutrition Objectives/Methods/Bvaluation
nt Public Health De rtment St. P ul Divi i n ,
Ramsev Cou y pa / a s o of
Public Health
�
o OBJBCTIVS 1: TO RBDUCB THB INCIDBNCB OF LOW BIRTHWBIGaT BIRTHS
TO 6.6$ OR LBSS IN THE WIC POPULATION AND 3$ OR
LSSS IN TBB MCH GRANT POPULATION; AND TO RBDUCB i
BY 33$ THE INCIDBNCB OF ANBMIA, GROWTH PROBLEMS,
OBBSITY, HYPBRTBNSION AND HYPBRCHOLEST$ROI,B1rIIA IN ,
THE POPULATIONS COUNSBLSD AT NUTRITION CLINICS.
Method la: To rovide reschool screenin services to �
P P 9
�-;000 children per year.
Evaluation la: Ninety-five percent of those children will �
receive individualized growth and outreach
� assessments� �
Method lb: To provide individual nutrition counseling to �
3,000 clients in 5,000 visits per year.
Evaluation lb: Sixty percent of clients receiving nutrition �
intervention for anemia will have normal hgb.
on c�t. within six months.
Sixty percent of children receiving nutrition �
intervention will achieve the quality
assurance standard for weight gain within
six months. �
Fifty percent of adults receiving nutrition
intervention for underweight will achieve �
quality assurance standard within six months.
Thirty percent of children less than age 5
receiving nutrition intervention for short �
stature will achieve the 5th percentile on
the NCHS qrowth grid within one year.
Fifty percent of clients with elevated �'
cholesterol ( >200 mg/dl) who receive
nutrition intervention will lower their �
cholesterol by 10� within six months.
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Nutrition Ob7ectives/Methods/Bvaluation
tForty-five percent of children over the age
of 2, teens and adults receiving nutrition
intervention for overweight will achieve the
� quality assurance standard for their age
within six months.
� -----
Method lc: To provide WIC services to 19,400 persons
, annually in 138,000 clinic visits (subject
to change based on MDH caseload assignments. )
Evaluation lc: Data are collected monthly to document
� and monitor caseload.
Less than or equal to 6.6� of infants
, born to women participating in WIC at
least three months during pregnancy will be
low birthweight ( <2500 grams) by
� December 31, 1991.
Fifty percent of WIC clients receiving
nutrition intervention for anemia will have
� normal hemoglobin or hematocrit within six
months by December 31, 1991.
� Twenty percent of children less than age 5
receiving nutrition intervention for short
stature will achieve the 5th percentile on
the NCHS growth grid within six months by
� December 31, 1991.
Fifty percent of children participating in
� WIC and receiving nutrition intervention
for underweight will achieve weight/heiqht
>10$ within six months by December 31, 1991.
� Thirty-five percent of children over the age
of 2 receivinq nutrition intervention for
overweight will achieve the quality assurance
� standard for their age within six months by
December 31, 1991.
� -----
O OBJBCTIVS 2: TO REDUCS THB PRBVALSNCB OF CHRONIC ILLNSSS/
DISABILITIBS ASSOCIATBD WITH POOR NUTRITION AND
� THE PRBVALBNC$ OF CHRONIC DISEASB ASSOCIATBD WITH
OBBSITY BY WRITING AND DISTRIBUTING 90 BDITIONS
OF PROGRAM PRODUCBD ARTICLBS, NBWSLBTTERS, PRESS
� RBLEASBS, INSBRTS TO A DOCUMENTBD INITIAL
CIRCULATION OF 2 MILLION PBRSONS.
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Nutrition Ob7ectives/Methods/Evaluation
�
Method 2a Offer age-specific editions of Good Food for �
-f: Kids through the creation of four additional
quarterly editions.
Write and submit to community newspapers 15 �
additional articles with an area-specific
nutrition focus. ,
Develop and produce two new educational
videos for Southeast Asians.
Develop and publish monthly issues of Food �
Facts newsletter for WIC participants.
Develop and produce 12 WIC Food Facts cooking �
videos (to be aired on Ch. 18 and tapes used
in WIC clinics. ) These same tapes are used �
for WIC outreach. ( lc)
Continue distribution of Nutrition Express
for Seniors. �
Evaluation 2a
-f: Annual evaluation is done of target �
audiences and appropriateness of vehicles
selected.
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o OBJSCTIVS 3: TO RSDUCB THB PRSVALBNCB OF CHRONIC ILLNBSS/ '
DISABILITIBS ASSOCIATBD WITH POOR NUTRITION AND
THB PRBVALBNCB OF CHRONIC DISBASB ASSOCIATSD WITH
OBBSITY THROUGH THB PROVI�ION OF ACCURATS �
NUTRITION INFORI�IATION TO 20,000 RAMSBY COUNTY
RESIDBNTS AT VARIOOS SBRVICB SBTTINGS USBD
BXTBNSIVSLY-BY_HIGB RISR GROUPS. �
Method 3a: Staff community education classes, parenting �
classes, support groups, grocery store tours,
refugee classes, wellness and retirement
groups, and other presentations on request. �
3b: Staff weekly classes at Women's Advocates.
3c: Offer classes to 6,000 students (K-12 ) within ,
the St. Paul/Ramsey County school system.
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Nutrition Ob]ectives/Methods/Bvaluation
, 3d: Answer hone re uests and or rovide inform i n
p q / p at o
by mail.
, 3e: Contingent on receipt of funding, implement
point of purchase education program in one
, Hispanic and one Southeast Asian food market.
3f: Offer new, mini-grocery store tours to teen
, 4-H members at area schools.
3g: Present information on nutrition for persons
with AIDS to 200 trained care qivers.
� 3h: Pilot nutrition education components in two
summer food program sites, to be implemented by
� volunteers.
3i: Offer weight control and/or self-esteem and
� body image presentations to residents of group
homes on request.
3j : Notify 5,000 commodity food recipients of
, potential eligibility for existing sources of
additional food.
� 3k: Contingent on student assistance, staff health
fairs/community events on request.
Evaluation 3a-k: A. Participant evaluation completed by
� 90� of persons attending the following
types of classes/presentations:
-Community Education classes
� -Parenting classes
-Grocery Store Tours
-Support Groups
� -Schools (if aqe appropriate)
B. Information requested provided within
48 hours.
� -----
�
o OBJBCTIVS 4: TO ASSURB TBB PROVISION OF ACCURATB NUTRITION
� INFORM�TION TO HEALTH, BDUCATION, AND SOCIAL
SERVICB PROFBSSIONALS WHO CAN ADDRBSS NUTRITION
ISSUSS IN THBIR WORR WITH CLIBNTS BY PROVIDING
600 CONSULTANTS ANNUALLY AND 50 INSBRVICBS TO
� 1,000 PARTICIPANTS.
� 169
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Nutrition Obiectives/Methods/Bvaluation
�
Method 4a: Annual presentation to community clinic �
staffs on hunqer/sources of food.
4b: Orientation provided to each new PHN on �
Ramsey County food programs.
4c: Conduct two mini-inservices annually for �
employees of SPRCNP on cultural food
preferences.
4d: Develop inservice on Hmong, culturally �
acceptable approaches to diabetic and heart-
healthy diets.
4e: Continue consultations formerly provided, as ,
requested.
4f: Menu consultations for group homes, detention �
centers as requested.
4g: Pilot a cultural awareness component in ,
St. Paul School menus (Homecroft School) .
4h: Offer food service consultation to White Bear �
Lake, Maplewood, and Roseville School food
service staff.
Evaluation 4a- �
h: Evaluations of inservices will be
conducted.
Volume of consultation requests. �
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o OBJECTIVS 5: TO ASSURS ACCBSS TO ADBQUAT$ NUTRITIOUS FOOD
FOR 1,450 RAMSBY COUNTY RESIDBNTS WITH LIMITED �
FINANCIAL RSSOURCBS.
• ----- �
Method 5a. To promote annually, legislation surrounding
food access issues beneficial to Ramsey �
County residents.
Evaluation 5a: Legislation is monitored and the efforts
of legislative activity on Ramsey County 1
residents documented.
170 �
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Nutrition Oblectives/Methods/Bvaluation
� -----
Method Sb: To increase access to additional food for
� adults and children in Ramsey County by
working to expand existing programs such as
the Swnmer Food Program and Fare Share.
� Evaluation 5b: To document the increase in food program
access in Ramsey County related to our
� efforts.
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Nutrition Inventory
�
o American Cancer Society, 3316 W. 66th Street, Minneapolis
o American Diabetes Association, MN Affiliate, 3005 Ottawa Avenue S. ,
St. Louis Park �
o American Heart Association, MN Affiliate, 4701 W. 77th Street,
Minneapolis
o Chrysalis Center for Women, 550 Rice Street, St. Paul �
o College of St. Catherine, 2004 Randolph Avenue, St. Paul
o Community Clinics:
-Face to Face, 642 E. 7th Street, St. Paul �
-Family Tree, 1619 Dayton Avenue, St. Paul
-Model Cities, 430 N. Dale Street, St. Paul
-North End, 135 Manitoba Street, St. Paul
-United Family Practice/Helping Hand, 545 W. 7th Street, St. Paul �
-West Side, 153 Concord Street, St. Paul
o Dairy, Food and Nutrition Council of Minnesota, 2015 Rice Street,
St. Paul �
o Early Childhood and Family Education Programs (ECFEP)
-St. Paul
-Moundsview �
-North St. Paul
-Roseville
-White Bear Lake
o Expanded Food and Nutrition Program (EFNEP) , U of M, Food Science �
and Nutrition Building, Room 167, 1334 Eckles Avenue, St. Paul
o Family Services of Greater St. Paul, 166 E. Fourth Street, St. Paul
o Fare Share, 150 Eva, P.O. Box 7212, St. Paul �
o Federal Food and Drug Administration, 240 Hennepin Avenue,
Minneapolis
o First Call for Help, 100 S. Robert Street, St. Paul
o Health Start, 640 Jackson Street, St. Paul �
o International Diabetes Center, 4959 Excelsior Boulevard, St. Louis
Park
o Lactation Resource Center, 333 Smith Avenue N. , St. Paul �
o March of Dimes, Twin Cities Chapter, 6701 Penn Avenue S. ,
Minneapolis
o Minnesota Board on Aging, 204 Metro Square, 7th and Robert, St. �
Paul
o Minnesota Department of Education, Child Nutrition, School
Management Service Division, 8th Floor Capitol Square, 550 Cedar
Street, St. Paul ,
o Minnesota Dietetic Association, 1821 University Avenue, Suite 280,
St. Paul
o Minnesota Extension Service, 2020 White Bear Avenue, St. Paul �
o Minnesota Food, Education and Resource Center, 708 3rd Street
South, Suite 300, Minneapolis
o Minnesota Nutrition Council, Inc. ,
o Minnesota State Health Department, Nutrition Section, P.O. Box
9441, 717 S.E. Delaware Street, Minneapolis
o Mothers and Children Program (MAC) , 1140 Gervais, Maplewood
,
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Nutrition Inventory
, o Resources for Child Caring, 450 N. Syndicate Street, St. Paul
o The Minnesota Council Against Fraud, Box 112, Riverplace, 43
Mainstreet S.E. , Minneapolis
� o Twin Cities Consulting Dietitians Practice Group, 5020 W. Lake
Street, Minneapolis
o Twin Cities District Dietetic Association, 1821 University Avenue
� W. , Suite 280, St. Paul
o University of Minnesota School of Public Health, Nutrition and
Human Development, Minneapolis; Department of Food Science and
� Nutrition, 1337 Eckles Street, St. Paul
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Dental Problems/Goals
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PROBLEM 48. High prevalence of gum disease in general population
, PROBLEM 49: High prevalence of dental caries in low-income people
PROBLEM 50: Increasing incidence of baby bottle caries
,
GOAL 48-50: To eliminate the incidence of gum disease in the general
� population, to reduce to a minimum the incidence of
dental caries and assure access to dental care for all
residents of Ramsey County, and to eliminate the
incidence of baby bottle caries
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Dental Rey Data
h f 30 ,
1. Nationally, it is estimated that 75� of adults over t e age o
are affected by periodontal disease. Fifty percent of children in
the U.S. have gingivitis, the first stage of periodontal disease. ,
2 . National statistics indicate that low income children have four
times as many cavities as non-low income children. �
3. A recent Wilder Foundation study of Ramsey County noted that 16�
of middle to high income 4-5 year olds and 19.5$ of low income 4-5 �
year olds in the County have never been to the dentist.
4. The incidence of children with baby bottle caries (decay) has been
increasing in recent years at the SPDPH dental clinic, especially �
among low income children.
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Dental Objectives/Methods/Bvaluation
, . P 1 Di i i n f li H 1 R li 8 1
St au v s o o Pub c ea th/ amsey County Pub c ea th
� Department
o OBJECTIVE 1: TO ASSURE THE PROVISION OF HIGH QUALITY,
� ACCBSSIBLS CLINIC-BASBD DBNTAL CARB ON A SLIDING
FBB SCALE TO ALL LOW-INCOI� UNINSURBD AND
UNDBRINSURBD RAI�ISEY COUNTY RBSIDENTS.
� (PROBLBMS 48-50)
� Method la: Funding is provided to three Community
Clinics (United Family Practice/Helping Hand
Health Center, Model Cities Health Center,
� and West Side Community Health Center) that
provide dental care to subsidize the cost of
care on a sliding fee scale to low income,
� under- and uninsured Ramsey County residents.
Evaluation 2a: Data are collected on numbers of clients and
services provided as well as financial
� status. (City and County funding covers only
a portion of the total costs for this
service. )
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Dental ObjectivesjMethods/Evaluation �
St. Paul Division of Public Health ,
• OBJECTIVE 1: TO REDIICE THE RATES OF DENTAL DISEASE IN ST. PAUL
RESIDENTS AND TO DECREASE THE NUMBER OF CAVITIES �
PER DIVISION OF PUBLIC HEALTH CLINIC PATIENT FROM
4.7 TO 3.5 BY DECEMBER 31, 1993.
(PROBLEMS 48, 49 AND 50) �
Method la: The St. Paul Division of Public Health provides ,
dental services including oral examinations,
prophylaxis, sealants, fluoride treatments and
necessary therapeutic treatment. �
Evaluation la: Data are collected on numbers of clients and
services provided to St. Paul residents . �
Monitoring of other low cost dental providers
available in St. Paul is also completed for
referral purposes, and to ensure that
residents have service options. In 1990, �
these services were provided to 675 St. Paul
residents, seen for 1,854 visits, primarily
by children and young adults under the age of �
21 on a sliding fee scale.
Method lb: Dental education throu h rou resentations one- ,
g g P P ,
on-one instruction and brochures is provided to
high risk individuals, or persons responsible for �
these individuals, and the community on the most
effective methods of preventing oral disease.
Evaluation lb: Data are collected on the number of �
individuals educated, and as evidenced in
reduction in number of cavities seen in the
DPH clinic population. ,
Method lc: Referrals to other community resources are made to ,
individuals requesting dental information and/or
service as appropriate and requested. ,
Evaluation lc: Referral information is regularly updated to
ensure that accurate information is provided.
Data could be collected to indicate the �
volume and type of refe=rals made.
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Dental Inventory
,
o Model Cities Health Center, 430 N. Dale, St. Paul
� o St. Paul Division of Public Health, 555 Cedar Street, St. Paul
o United Family Practice/Helping Hand Health Center, 545 W. 7th
Street, St. Paul
� o University of Minnesota Dental Clinic, Minneapolis
o West Side Health Center, 153 Concord Street, St. Paul
� In addition to these public providers, there are approximately 300
private dentists practicing in Ramsey County. Out of this total,
roughly 20$ currently treat Medical Assistance recipients, all though
the majority of these will not accept new M.A. patients, and are
� considering ending service to this population. (Data come from a
Winter, 1990-91 survey of all dentists in Ramsey County. )
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■ 1992-1995 Community Healtb Services Plan Cover Form,
■ �
NAME OF CONiMUNITY IiEALTH BOARD
� �....,.>�.,��:x:��. «��..:.... ..
Ramsey County ::��w��?�c�€;_�.1�:��.�;��«>>�':::<�>:>S��'::�
, APPROVAL OF PLAN AND BUDGET
, Date Plaa Approved By Community Health Board �� 91
Date(s) Plaa Approved By Couaty Board(s) Date Approved
� Ramsey County �� 91
��—
� ��-
��
� —/_/
, ��
SUBSIDY REQUFST 1992 CHS 1993 CHS
�' . Subsidy Request Subsidy Request
Total Community Healt6 Board Reqnest S 1 .694�,900 s 1 �694�900
, Individual county requests
S S
, . S S
S S
, S S
S S
� S S
, CRS ADMIMSTRATOR
Name and Address � '
, Rob Fulton, Director, Ramsey County Public Health Department,
150 E. Kellogg Blvd. , Suite 610, St. Paul , �IN 55101
� FISCAL MANAGEMENT OFFICER
� Name and Address
— James Van Houdt, Director, Budgeting and Accounting, Room 36 Courthouse, .
15 West Kello44 Blvd. . St. Paul . MN 55102
, � Cover Form — page 1 of 2
, . ' � 179 . .
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ASSURANCES AND AGREEMENTS
BY SIGNATURE,THE AUTHOWZED OFFICIAL AGREED AND ASSURES THAT: �
1. Services will be provided in accordance with Stat� and Federal laws, niles and policies.
2. The Community Health Board will comply with state and federal requirements for equal opportunity ,
employment.
3. The Board will comply with state and federal requirements relating to data privacy or confidentiality ,
. of protected informat�oa
4. The Board will provide the Minnesota Department of Health with information referenced in the
CHS plan where applicable. - � �
5. Standazds for prop�rams or activities will be used in carrying out affected programs or activities where
those standards e�ast.
6. The requirements for full community participatioq as defined in Minnesota Rules 4700.1800, have �
beea meG� �
7. The community Health Advisory Committee (_or Health Task Force of any Human Services Board
Advisory Committee in the county where applicable [Mian. Stat.402.03]), shall meet the composition �
and reporting requirements of the Commumty Health Services Advisory Committee required by
Mianesota Statute. .
8. 'The Board will comply with all standards relating to fiscal accountability that apply to the Minnesota ,
Depaztment of Health, specifically.
a. The local match identified ia the budget submissioa complies with the�definidon spe�ed in .
Mina. Stat. 145A13. �' ��
b. The Board will submit plan and budget revisions to the Commissioner for prior approval ia
accordance with applicable statute, rule, and MDH policy.
c. Reports will be filed with the Commissioner of Health in accordance with applicable statute, ,
rule, and MDH policy.
d The Board will maintain a Financial Management System that provides:
• 1) Accurate, current, aad complete disclosure of the financial results of each activity. ,
2) Records that identify adequately the source and ap licadon of funds for subsidy
supported adivities. These records shall contain�ormationpertaining to subs�dy
awards aad authorizations, obligations, unobligated balances, Tiabilities ,
(encumbrances), outlays and income.
3) Demonstration that the Boazd has effective control over the accountability for all
. fuads, Property and other assets. �
4) Comparison of adual obligations with budget amounts for each activity.
� � Accounting records that are supported by source documentatioa �
6) Audits that can be made by or at.the diredion of the Board or the Department of
' Health. CHS financial records will be retained until audited, with the following
qualifications: � ' �
aa) The records will be retained beyond this period if audit fiadings have not .
. been resolved.
bb) Records for non-expendable property wluch was acqu�ired with subsidy �
funds will be retained for three years after its final disposition.
� �
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Cover Form - page 2 of 3 �
� � . 180 ,
� � � �i-���
� 9. The Board will maintain records of the following materials for review for the duration of the Plan.
(Note: This does not preclude other requirements stipulated in the Community Health Board's
retention schedule.]
� a Copies of the Joint Powers Agreement forming the Community Health Board-
b. Agreements establishing a Board of Health or Boards of Health within the area of the
, Community Health Board.
c. Organization cbart of the Community Health Board structure that identifies major program
adivities, advisory groups, and liaes of authority aad accouatability.
, d. A list of all city/'county local ordinances or other local regulations related to Community
Health Services revised within the past two years.
a Copies of all public meeting notices aad minutes.
� � General roster for Commuaity Health Service Mailings.
g, Community Health Sen+ices Advisory Committee bylaws, meeting notices, minutes and
� attendance records.
h. Summary of public comments or testimony on the proposed Plan.
i. Copies of contracts/purchase of service agreements with other organizations. .
, j. Environmental Health, Disease Prevention aad Coatrol, aad other agreements to exercise
the Commissioner of Health's authority.
� Application is made for a subsidy under the provisions of the Local Public Health Act
in the amount� and for the purposes stated herein. The Community Health Board
agrees to comply with conditions and reporting requirements consistent with applicable
� Minnesota Statute and Rule.
, * SIGNATURE ___ .
TITLE Di rector, Publ i c Hea lth De�artment DATE 6
� •�This form must be,signed by the Chair or�ce Chair of the Community Health Board, or aa agent
appointed by resolut�oa of the Community Health Board.
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� . Cover Form - page 3 of 3 . _
, . 181
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1992-1995 Community Health Services Plan Cover Form ,
NAME OF COMMUNITY HEALTH BOARD �
:::>:::::::::::::;:>::,::::.;.<....:.:.::::���::�:;:>::>:::<:;�<<::::;:::><.:>�:s>::>:<:>:
Saint Paul Division of Public Health �a��::��y��.�.:�,�;���,;;.�:;:;
APPROVAL OF PLAN AND BUDGET ,
Date Plan Approved By Commuaity Health Board 10� 3 � 91 ,
Date(s) Plan Approved By County Board(s) Date Approved �
Ramsey County Board 10��91
� � �
. _�—�—
—�_�_ ,
—�—�—
. —/�— �
SUBSIDY REQUEST 1992 CHS 1993 CHS �
Subsidy Request Subsidy Request
Total Commuaity Health Board Request $ 949,865 a 949,865 ,
Individual county requests
$ $ ,
S s
S $ �
S $
S $ ,
$ S
,
CHS ADMINISTRATOR
Name and Address �
Katherine Cairns 555 Cedar Street, St. Paul, MN 55101
FISCAL MANAGEMENT OFFICER �
Name and Address
Katherine Cairns 555 Cedar Street, St. Paul, MN 55101 ,
Cover F��an — page 1 of 2
182 ,
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� ASSURANCES AND AGREEMENTS
� BY SIGNATURE,THE AUTHORIZED OFFICIAL AGREED AND ASSURES THAT:
, 1. Services will be provided in accordance with State and Federal laws, rules and policies.
2. The Community Health Board will comply with state and federal requirements for equal opportunity
employment.
, 3. The Board wiIl comply with state and federal requirements relating to data privacy or confidentiality
of protected information.
4. The Board will provide the Minnesota Department of Health with information referenced in the
, CHS plan where applicable.
5. Standards for programs or activities will be used ia carrying out affected programs or activities where
those staadards exist. �
� 6. The requirements for full community participation, as defined in Minnesota Rules 4700.1800, have
beea met.
7, The community Health Advisory Committee (or Health Task Force of any Human Services Board
, Advisory Committee in the county where appIicable [Minn. Stat. 402.03]), shall meet the composition
aad reporting requirements of the Community Health Services Advisory Committee required by
Minnesota Statute.
� 8. The Boazd will comply with all standards relating to fiscal accountability that apply to the Minnesota
Department of Health, specifically.
a. The local match identiFed in the budget submission complies with the definition specified in
� Minn. Stat. 145A.13.
b. The Board will submit plan and budget revisions to the Commissioner for prior approval in
accordance with applicable statute, rule, and MDH policy.
, c. Reports will be filed with the Commissioner of Health in accordance with applicable statute,
rule, and MDH policy.
d. The Board will maintain a F'inancial Maaagement System that provides:
� 1) Accurate, current, and complete disclosure of the fiaaacial results of each acdvity.
2) Records that identify adequately the source and ap licatioa of funds for subsidy
supported aciivities. These records shall contaia �ormadon pertaining to subsidy
� awazds and authorizadons, obligations, unobligated balances, &abilities
(encumbrances), outlays and income.
� 3) Demonstration that the Board has effective control over the accountability for all
funds, property and other assets.
4) Comparison of actual obligadons with budget amounts for each activity.
� � Accounting records that aze supported by source documentation.
6) Audits that can be made by or at.the direction of the Board or the Department of
Health. CHS fmancial records will be retained until audited,with the following
� qualifications:
aa) The records will be retaiaed beyond this period if audit fmdings have not
been resolved.
�. bb). Records for non-expendable property wh'ich was a uired with subsidy
funds will be retained for three years after its fmal�positioa. �
,
Cover Form - page 2 of 3
, 183
. ,
9. The Board will maintain records of the following materials for review for the duration of the Plan. ,
[Note: This dces aot preclude other requirements stipulated in the Community Health Board's
retention schedule.] �
a. Copies of the Joint Powers Agreement forming the Community Health Boazd.
b. Agreements establishing a Board of Health or Boards of Health within the area of the
Community Health Board. ,
c. Organization chart of the Community Health Board structure that ideatifies major program
activ�ties, advisory groups, and lines of authority and accountability.
d A list of all city/county local ordinances or other local reguladons related to Community �
Health Services revised within the past two years.
e. Copies of all public meeting notices and minutes.
f. General roster for Community Health Service Ma;l�. ,
g. Community Health Services Advisory Committee bylaws, meeting notices, minutes and
attendance records. �
h. Summary of public comments or testimony on the proposed Plan.
i. Copies of contracts/purchase of service agreements with other organizations. �
j. Environmental Health, Disease Prevention and Control, and other agreements to exercise
the Commissioner of Health's authority.
Application is made for a subsid under the rovisions of the Local Public Health Act �
Y P
in the amount and for the purposes stated herein. The Community Health Board
agrees to comply with conditions and reporting requirements consistent with applicable ,
Minnesota Statute and Rule.
. • ,* SIGNATLTRE •
TITLE Public Health Serices Manager DATE � �
�
* This form must be signed by the Chair or Vice Chair of the Community Health Board, or an agent
appointed by resolution of the Community Health Board.
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Cover Form - page 3 of 3 t
184
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, MDH-COMMUNITY HEALTH BOARD IMMUNIZATION PROGRAM AGREEMENT
, T6e Ramsey County Community Health Board agrees to:
1) Administer Department-supplied vaccine in accordance with Minnesota Department of Health policy to use
federally supported vaccines for children and individuaLs who lack financial resources to pay for these vaccines.
, 2) 'Provide copies of the current appropriate "Important Information Statements" (IIS) or "Vaccine Information
Pamphlets" (VIP) to all vaccine recipients or their parents or legal representadves receiving immunizations in
� public clinic settings and to private physicians for use in accordance with the condidons specified in the Private
Physician Certi6cation Form, dated 4/91. Community Health Boards may include appropriate identification on
the forms. Any other addition to the forms, or variations from the language or format of them must have the
prior written approval of the Diredor of the Center for Prevention Services, Centers for Disease Control (CDC).
� Any request for change must be submitted to the Minnesota Department of Health (MDH) which will forward
the request to the Centers. The appropriate Important Information Statements at the time of this agreement are
dated: Polio- 3/1/83; MMR - 1/1/88; DTP/DT/Td - 1/1/88; Haemophilus b Conjugate - 10/19/90; and
Hepatitis B • 2/1/90. When the VIPs become available, the MDH agrees to provide these to the Community
� Health Board at the earliest possible date.
3) Obtain documentation of the receipt by vaccine recipients or their parents or legal representatives of the
� "Important Information Statements" (IIS) or the "Vaccine Information Pamphlets" (VIP) relating to the vaccine
administered The documentation shall consist of the signed lower portion of the IIS, the tear out portion of the
VIP, or a separate signature card or log sheet which contains the followin�
� "I have read or have had explained to me the informadon contained in the Important
Information Statement(s) or Vaccine Information Pamphlet(s) about the disease(s) and the
vaccine(s). I have had a chance to ask questions which were answered to my satisfadion. I
believe I understand the benefits and risks of the vaccine(s) and request that the vaccine(s) •
� indicated below be given to me or to the person named below for whom I am authorized to
make this request."
This statement must appear at the top of the signature card or log sheet and the form must include at a
, minimum the following enUies: Name, address, date of birth, age at the time of immunization, type of vaccine(s),
c,linic/office address, date of immunization, site of immunizatioq manufacturer and lot number,�signature of
person to receive vaccine or person authorized to make the request, date of signature, signature and title of
� person administering vaceine and date printed on the appropriate IIS or VIP.
4) Obtain a signed copy of the "Private Physician Certification" form at least annuallv from all physicians to
whom the Community Health Board furnishes vaccine which is to be used in private practicc.
t � Fstablish procedures for the retention of the signed portion of the IIS, VIP, Private Physician Certification
Form, and otber types of approved documentation for at least ten years following the end of the calendar year in
� which the forms are signed and, upon written request, furnish copies of the forms to the MDH or the CDC. In
additioq if a notioe of a claim or a lawsuit has been made, the IIS, VIP, Private Physician Certification Form,
and other types of approved documeatation pertaining to the matter must be retained until after a final
disposition of the claim or litigation (including appeals) has been made.
� 6) Assure that public clinics, schools and other agencies to wluch the Community Health Board redistributes
vaccine agree to the use and retendon of IIS or VIPs as specified in 2, 3, and 5.
� 'n Assure that, in the case of a school-based program or other programs where the statements or pamplilets are
to be read and signed in advance of the immunizadon by a parent, guardian or other authorized person who will
not be present at the immunization clinic when the vaccination is�veq procedures shall be established and made
� known for answering quesdons by telephone or otherwise.
8) Assure that person(s) are available at each immunization clinic to ensure that prospective vaccine recipients
or their pazents or legal representatives can read or have read to them the information provided, and to answer
, questions about the vaccine, its expeded benefits, its normal risks, its contraindications (special warnings to
vaccinees with low resistance to infections), alternatives to immuni7atioq and to provide advice regarding medical
, 185
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assistance in tho event of suspected vaccine reactions. Clinics serving large numbers of persons for whom Eaglish
is not a first language must provide the writtea informadon in the native language. Transladons of IIS or VIPs �
aze available from the Minnesota Department of Health.
9) Assure that the person administering the IIS or VIP routinely ask all vaccine recipients or their parents or
legal representatives if they understand the information provided to them and if they have any questions. ,
10) Desi�ate a Biologics Control Officer who will have overall responsibility for the implementation of MDH
vaccine policies aad procedures which shall include a) ordering, receiving, storing, and handling vaccines from the �
MDH, b) redistnbuting vacane to physicians and other clinics if the agency so chooses and assuring
implementation of such policies with these other providers, c) returning vaccines to the MDH, and d) monitoring
and reporting vaccine usage to the MDH.
The Biolo�cs Control Officer for the cet�/county of RamseY � �s Jane Harper �
The Biolo�cs Control Officer for the county of ��
The Biologics Control OfScer for the county of �� �
The Biologics Control Officer for the county of ��
11) Designate a vaccine reacdon coordinator and place the telephone number of the coordinator on each IIS or
. VIP as the number to call to report a possible vaaane reaction. �
The readion coordinator for the�/county of Rdm� y � .l�nP H�r�Pr
� T'he reacxion coordinator for the county of � �
The readion coordinator for the county of �
The readion coordinator for the couaty of �
12) Report to the MDH all illnesses in vaccinees which a) began wichin 30 days of receipt of vaccine and which ,
are severe enough to require hospitalization or a visit to a physician or other medical care personnel, or b) meet .
the reporting criteria established under the Nadonal Childhood Vaccine Injury Act. Boazds must use the CDC
report form "Vaccine Adverse Event Reporting Syst4m" (Form VAERS-1). �
13) Provide the vaccine,whether administered in public clinics or by private physicians,without char�ng the
recipient for the cost of the vaccines. If an administratioa fee is chazged, information must be prominendy ,
displayed which indicates that no one receiving an immunization in public clinics may be denied vaccine provided
through the MDH for failure to pay the administration fee or failure to make a donadon to the providers
whether public or private.
14) Submit a quarterly vaccine usage and inventory report by the lOth of the month following the report period. �
� A report must be filed even if no vaccines were administered or distn'buted. Use the 1vIDH form "Quarterly
Report of Vaccines Administered and Distributed" and"Quarterly Inventory of Vaccine/Biologics."
15� Screen vaccinees for current Medical Assistance (MA) eligibility and bill the Medical Assistance program i
using modi6ed billing procedures to enable the MDH to receive reimbursement for the vaccine.
By signature, the authorized official or agent agrees and has the authonty to agre
e to �
comply with these conditions and reporting requirements consistent with applicable NIDH
Rules and the Local Public Health Act. In addition, by signature below, the authorized �
official or agent assures full compli ce with all items stated herein.
'SIGNATURE � �
1TTLE Director of Public Health DATE: �
* This form must be signed by the Chairperson or Vice-Chairperson of the Community Health Boazd, or an
agent appointed by resoludon of the Community Health Board. ,
186 �
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MDH-COMMUNITY HEALTH BOARD IMMiJNIZATION PROGRAM AGREEMENT
�
� �e Saint Paul Division of Public Health Community Health Board agrees
to:
� 1) Admiaister Department-supplied vacc:ine in accordance with MDH policy to use federally supported
vaccines for children and individuals who lack financial resources to pay for these vaccines.
2) Provide the appropriate "Important Information" forms to a�l vaccinees (if minors, then to parents or
� guardians) receiving vaccinations in public clinic settings and to private physicians if they elect to_use..the..
forms in accordance with the conditions specified in the "Private Physician Certification" form, ���;���g.
Community Health Boards may include appropriate identification on the forms. Any other addition to the
forms, or variations from the language must have the prior written approval of the Director, Centers for
� Disease Control (CDC). Any request for change must be submitted to the Mianesota Department of Health
(MDH) which will forward the request to the Centers. The appropriate;Important Information forms at the
time.of,this.,agreement_a;e.dated:.,Polio..-.3_l 83• MMR - 1 1 88• DTP >.
:.�::::::::::::::::::...;.._:::
...:..:. / , / / /n�'/Td - 1/1/88;��ai5g�iltis:;�
�?�.��~������.��p���S.����,�9Q If updated forms become available, the MDH agrees.to
� provide these to the Community Health Board at the earliest possible date.
3) Obtain documentation of the receipt by vaccinees (if minors, by pazents or guardians) of the Important
� Information form relating to the vaccine administered. The documentation shall consist of the signed lower
portion of the Important Iaformation form or a separate signature card which contains the following.
"I have read or have had explained to me the information contained in the Important Information
� statemeat(s) about the disease(s) and the vaccine(s). I have had a chance to ask questions which
were answered to my satisfaction. I believe I understand the benefits and risks of the vaccine(s) and
request that the vaccine(s) indicated below be given to me or to the person named below for whom I
� am authorized to make this request."
This statement must appear at the top of the signature card or log sheet and the form must include at a
minimum the following entries: name, address, date of bir.th,.:age..at.:the time of immunization, type of
� vaccine(s), clinic identification, date of vaccinatio ��������' ���� � '" �
n, SiC�:�:;�i�ti�zrt, manufacturer and lot number,
signature of person to receive vaccine or person authorized�to�make the re uest date of si
-- printed on the appropriate Important Informatioa form. 9 � �ature, and date
� 4) Obtain a signed copy of the "Private Physician Certificadon" form �t least annuallv from all physicians to
whom the Community Health Board furnishes vaccine which is to be used in private practice. �r-acw
� � Establish procedures for the retention of the signed portion of the Important Information form and
Private Physician Certification form, and other types of approved documentation for at least ten years
following the end of the calendar year in which the forms are signed and, upon written request, furnish
� copies of the forms to the MDH or the CDC. In addition, if a notice of a claim or a lawsuit has been made,
the Important Information Statement, Private Physician Certification form, and other types of approved
documentation pertaining to the matter should be retained until after a final disposition of the claim or
, litigation (iacluding appeals).
6) Assure that public clinics, schools and other agencies to which the Community Health Board redistributes
vaccine agree to the use and retention of Important Information forms as specified in 2, 3, aad 5.
, 'n Assure that, in the case of a school-based program or other programs where the informadon form is to
be read and signed in advance of the immunization by a parent,guardian or other authorized person who will
not be present at the immunization clinic when the vaccination is given, procedures shall be established and
� made known for answering questions by telephone or otherwise.
8) Assure that person(s) are available at each immunization clinic to ensure that prospective vaccinees (if
� minors, that parents or guardians) can read the information provided, and to answer questions about the
vaccine, its expected benefits, its normal risks, its contraindications (special warnings to vaccinees with low
resistance to infections), alternatives to vaccinatioq and to provide advice regarding medical assistance in the
event of suspected vaccine reactions. Clinics serving large numbers of persons for whom English is not a first
�
187
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laaguage must provide Important Information statemeats in their native language. Translations of Important
Information forms are available from the Minnesota Department of Health. ,
9) Assure that the person administering the Important Informadon form(s) routinely asks vaccinees (parents
or guardians) if they understaad the informadon provided to them and if they have any questions.
10) Designate a Biologics Control O�cer who will have overall responsibility for the implementation of �
MDH vaccine policies and procedures which shall include a) ordering, receiving, storing, and handling
vaccines from the MDH,b) redistributing vaccine to physicians and other clinics if the agency so chooses and
assuring implementation of such policies with these other providers, c) returning vacciaes to the MDH, and �
d) monitoriag and reporting vaccme usage to the MDH.
The Biologics Control O�cer(s) is/are: GeGe Nowicki, R.N.
11) Desigaate a vaccine reaction coordinator aad place the telephone aumber on each Important �
Informadon form as the number to call regarding vaccine reactions.
The reaction coordinator(s) for the agency is/aze• GeGe Nowicki, R.N. �
12) Report to the MDH all illnesses in vaccinees which a) began within 30 days of receipt of vaccine and
• which aze severe enough to require hospitalization or a visit to a physician or other medical care personnel, �
or b) meet the reporting criteria established under the National Childhood Vaccine Injury Act. Boazds must
use the CDC report form "Report of Adverse Event Following Immunizatioa."
13) Provide the vaccine,whether administered in public clinics or by private physicians, without charging the �
recipient for the cost of the vaccines. If an administration fee is charged, information must be prominendy
displayed which indicates that no one receiving an immunization in public clinics may be denied this vaccine
for failure to pay the administration fee or failure to make a donation to the provider. �
14) Submit a quarterly vaccine usage and inventory report by the lOth of the month following the report
period. A report must be filed even if no vaccines were administered or distributed. Use the MDH form
"Quarterl V..RePort.of Vaccines Administered and Distributed" and"C'�tii.��rl:�t;�uY�riti�i�r�5�€
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By signature, the authorized official or agent agrees and has the authority to agree to �
comply with these conditions and reporting requirements consistent with applicable
MDH Rules and the Local Public Health Act. In addition, by signature below, the
authorized official or agent assures full compliance with all items stated herein. �
. .
*SIGNATURE . �
�E Public Health Services Manager DA�' �' !
. �
* This form must be si�ed by the Chair or Vice-Chair of the Commuaity Health Board, or an agent �
appoiated by resolution by the Community I�ealth Board. .
�
. �
188 �
�
� RECORD �F AD TIVF: REQZJIREIV�NTS
� This record is to assure that the Community Health Board has addressed tUe
administrative requirements of the Local Public Health Act and its Rules.
� A. �JM11�LA�tY OF THE LOCAL PUBGIC HEALTH ACT REOUIREMENTS
145A.03 Subdivisioa 4. Membership: duties of chair. A 6oard of health must have at least five member,� one
, of whorn must be elected by the members as chair anci one as vice-chair.
How many members ari ffiere on your Community Heslth Board? 7
, Subdivision 5. Meetings. A board of health must lw/d meewegs at least twice a year and as
determined by its rules of procedu�. The board must adopt written procedures for tra�uacting business and must
keep a public necord of its transactions,frndings, and determuwtions
� List the dates of t6e mee� of your bosrd o[healtL in t6e past calendar year. .
1/16/90; 1/23/90; 2/6/90; . 2/13/90; 2/27/90; 3/6/90; 4/3/90; 4/10,/90;
� 4/24/90; 5/22/90; 6/12/90; 6/25/90; 7/10/90; 7/24/90; 8/7/90; 8/28/9Q;
9/25/90; 10/2/90; 10/16/90; 10/23/90; 11/20/90; 12/4/90; 12/11/90;
12/18/90 .
� Does your board 6ave written procedures? X Yes _No
Dces your board keep a public e�ecord? X Yes _No
� .
145A.11 Subdivision 3. (For Hennepin and Ramsey Counties only.)
, (b) The communiry health plan, budgeK or revision submitted w the county board �
� - »tust incorporate the community health plan, budgeK or nevision developed by any city
within its community health se�vice ana that hos a community health board
Does this plaa incorporate those cities? �Yes No
�
� 145A10 Subdivision 3. Medical Consultant Tht Community Heolth Board must appoi�c� employ, or contract
with a medical consultant
� � Please llst the name,address,and telephone number ot your medical coasultant(s).
Dr. Neal Holtan, St.- Paul Division of Public Health , 555 Cedar Street,
St. Paul , MN 55101 (612) 292-7712
� _ .
� Subdivision 10. State and local advisory committees. (b) The city councils or county boards that have
established or ane members of a Community Healtle Board must appoint a community health advrsory
comminec. Tiu conemittee must consrst of at least five members and must be generally representative of the
populadion and health cone providers of tlu conununity health service ar+ea
� � How many members are there on your advisory commtttee? .�1 �
Briefly describe on what basis they are appointed (e.g.,geographic representation,prnvider/consumer,
special interest,etc.). • •
Committee members are appointed by the Mayor of the City of St. Paul and .approved
. by the City Council and tfie County Board of Commissioners , and represent the �
� County both geographically as well as with both prnviders (physician, nurse, clinic •
and shelter directors) and consumers.
-�Administrative Requirements — Page 1 of 2
, � . 189 .
. ' �
(c)State a�rd local advisory conunittees must adopt bylaws o�oPe�inSPsocedunes.
Does yonr advisory commiitee Lave bylaws or prooedures? X Yes No ,
g, Si TMMA�ty OF RULE REQL1iREMENTS �!
4736.0030 Subpart 2 Communitv narticipation. ?7u plan must descnbe the p�cess used to plan community �
health services It must include:
B. A.rummary of the process used to encouna8���a�+�++h'P�P� in the development of the
proposed community health plan. Pa�ticipation nu�.st includt tlu following.
(1) Wiirten notice of thc rnitiation of the plan development process made to interested persons, including �
a�`ected provide� corrsuiner� and local gr�vernment officials The notice must include the procedunes by which
persons may participate in thot p�cess. It must desc�ibe hOw persons may obtain a sw:vnary of the proposed
pJan and how they may rieview the entin proposed plan. Tht»o�ict must be published in a local newspaper and
sent to individuals listed on a g�enerol msta for conununity health services mailings ntaintained by the ' �
Community Health Board
On what date(s)was sucL a noti«seat? 2/15/91 . 7/12/91 �
Was the notia published in a local newspaper? Yes No �
Newspaper(s) Date Pablished .
St. Paul Pioneer Press 2/21/91 Copyonflle?�Yes No �
� Copy on file? Yes No .
Copy on file? Yes No �
Dces your board maintain a�neral maillog rostec? X Yes l�fio � .
V so,dces It contain: Providers X Yes. No �
Consumers X Yes No
� Local Government �
Ot6cials �Yes No
Was notice sent to people on the general mailtng roster'! X Yes No
�
(2)A public meeting at which intensted persau will haNe the oppommity to comment on the proposed
plan. A summary of thc proposed plan must be made availoble to intenested persons at least 14 calendar days �
befon this meeting. A copy of the proposed plan must be available for public neview ot a designoted place. The
public meeling must be held at least 14 calendar days befone approval of a proposed communiry health plan by
the couney boand or 6oards�os descnbed in M'uaeesota Statute� section 14SA.11.
On what date was the plan ava�able for public review? 8/19/91 �
On what date was a summary of the proposed plan available to interested persons? 7 24 91
On what date(s) were public meetings held? . 1(1��f 9(1 �
� 2/19/91
� � 3 6 91 �
�1Z11L (�
. � \ y
. �
' Administrative Requirements — Page 2 of 2 �
190 _ � ,
�
� RECORD OF ADMINISTRATIVE REQUIREMENTS
lfiis record is to assure that the Community Health Boazd has addressed the
� administrative requirements of the Local Public Health Act and its Rules.
A. SUMMARY OF THE LOCAL PUBLIC HEALTH ACT REOUIREMENTS
� 145A.03 Subdivision 4. MembershiD: duties of chair. A board of health must have at least ftve members, one
oj whorn mus�be elec�ed by tht mtmbers as chai�and one as vice�hair.
� How many members are t6ere on your Community Health Board? �
Subdivision 5. M in . A 6oaid of health must hold meetings at least twice a year and as
determined 6y its n�les of procedure. Tht board must adopt wriuen procedures jor transacting business and must
� keep a public secord oj its transactions,findin&s, and detemiinations.
List the dates of the meetings of your board o[healW io t6e past calendar year.
� February 21, 1991 as the Boazd of Health. The City Council has discussed various
public health issues as part of their regular meetings on many additional dates
including April 16, 18, 23 and 25, May 7, 9, and 28, July 25 and August 6, 1991 .
� Dces your board have written procedures? g Yes No
Dces your board keep a public record? �Yes _No
�
� 145A.11 Subdivision 3. (For Flennepin and Ramsey Counties only.)
(b) The community health plan, budge� or revision submitted to t/:e county board
must incorporate the communiry heallh plan, budge� or revision developed by any city
within its community health service area that has a community health board
� L)oes this plan incorporate those cities? Yes No
� 145A.10 Subdivision 3. M i n 1 n . The Communi Health Board must a oin em lo or contract
ry rr 4 � Y�
with a medical consultant.
,� Please Ilst the name,address,and telep6one number of your medical consultant(s).
� Neal Holtan, M.D.
555 Cedar Street
St. Paul, MN 55101
612-292-7726
� Subdivision 10. �te and local advisory committees. (b) 7he city councils or county boards that have
es�ablished or are members oj a Comrnunity Health Board must appoint a community health advisory
comrninee. The committee rnust consrst of at least f ve mern6ers and rnust be generally representative of the
� population and heal�h ca�providers of the community health serviu orea
How many members are t6ere on your advisory committee? 21 City and County representatives
� Brietly describe on w6at basis they are appolated (e.g.,geograp6ic representatSon, provider/consumer,
speciai ioterest,etc.). Members are selected to represent both the City and the County.
City representatives are solicited through public notice and mailings, and
� include representation by geographic basis, as a provider or consumer, and in
response to their past experience and special interests. City members are
appointed by the Mayor and approved by the City Council.
Administrative Requirements — Page 1 of 2
� 191
�
{c) State and local advisory commirtees must adopt bylaws or operating procedures.
Does your advisory committee have byluws or procedures? X Yes No ,
B. SUMMARY OF RULE REOUIREMENTS �
4736.0030 Subpart 2. Communitv�icipation. The plan must despibe the process used to plan community �
heal[h services. Ic must include:
B. A summary of the process used to encourage full comrnunity participation in �he development of�he
proposed communiry health plan. Participotion�nust includt the following.
(1) Wiitten notice of the initiation of the plan development process made to interested persons, ineluding �
aJrecled provide�s, consumers, and local govemment o�cials. ?be notice must inelude the procedunes by which
persons may pa,ticipate rn that process. It must describe how persons rnay obtain a sumrnary oj the proposed
plan and how they rnay�+eview uie entire proposed plon. The notice must 6e published in a local newspaper and �
sent to individuals listed on a genera!roster fo�community health se�vices mailings maintained by the
Community Heal�le Board
On what date(s) was such a notice sent? 2/15/91. 7/12/91 �
Was the notice published in a local newspaper? �Yes No
Newspaper(s) DaGe Published
St. Paul Pioneer Press 2 21/91Copy oa t51e? X Yes No � �
Copy on Cle? Yes No �
Copy on t�le? Yes No �
Dces your board maintain a general mailing roster? ' �Yes No �
I[so, does It cootain: Providers �_Yes No
Consumecs �L Yes No
Local Government �
O[ticials X� Yes No
Was notice sent to people on We geaeral mailing rnster? X Yes No
�
(2)A publie meeting at which in[enested persorrs will have the opportunity�o comment on th�proposed
plan. A surnmary of�he proposed plan must be made available�o interested persons at least 14 calendar days �
before this meeting. A copy of the p�posed plan must be available for public review at a designated place. The
public meeting must be held at least 14 ealendar days before appr+oval of a proposed communiry health plan by
�he county board or boards as described in Minnesota Statutes, seclion 145A.11.
On what date was the plan available for public review? . 8/19/91 �
On what date was a summary of the proposed plan available to iaterested persons? 24 1 �
On what date(s) were public meetiags held? 3,�
8/7/91
�
�
� �
Administrative Requirements — Page Z of Z
192 �
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, Ramsey County Public Health Department
1991 Contracts and Purchase of Service Agreements
� Organization Service Contract Amount
SPDPH lab services unit price
� SPDPH medical consultation unit price
SPDPH family planning $6,750
Med Centers waiver home care unit price
Equity Services health aides unit price
� Medical Personnel Pool health aides unit price
Equity Services PCA service unit price
Integrated Home Care waiver home care $94,660
Upjohn health aides unit price
� Ramsey Badre & Assoc. Medicare cost report $3,500
Wilder Foundation parent outreach unit price
St. Paul Rehab Center PT,ST,OT $15, 103
� North End Block Nurse Block Nurse Program unit price
Highland Block Nurse Block Nurse Program unit price
St Anthony Block Nurse Block Nurse Program unit price
Wenck Associates engineering services $807,48
� Aptus haz waste disposal unit price
Composting Concepts composting $5,060
People Magic recycling education $9,900
� RECOMP recycling center $333,600
Falcon Heights recycling $5,662
Arden Hills recycling $20, 168
Maplewood recycling $62,927
� New Brighton recycling $47,562
Little Canada recycling $19,024
Vadnais Heights recycling $20,338
, Lauderdale recyclinq $5, 121
Gem Lake recycling $828
St. Paul recycling $559,041
N. St. Paul recyclinq $25,571
� Shoreview recycling $50,251
Roseville recycling $152 080
North Oaks recycling $6,857
� St. Anthony recycling $6, 182
White Bear Lake recycling $48,484
White Bear Township recyclinq $18,232
Nghbad. Energy Consortium phone answering/sw info $41,480
� Ramsey Co. Extension Svc. sw education $25,853
Face to Face community clinic $65, 125
Family Tree community clinic $65, 125
� North End community clinic $65, 125
West Side community clinic $65, 125
Model Cities community clinic $65, 125
Health Start community clinic $52,500
� Helping Hand community clinic $65, 125
FCC lease Roseville Schools $89,512
GLS lease Capital Community $16,695
� SSS lease St. John's Church $21,460
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,
�
1992-95 RAMSBY COUNTY-ST. PAUL CHS PLAN INDBX OF 1�IBTHODS
Disease Prevention and Control
�
32-37 - 1 - la, lb, le, li - Health Education - Pages 110, 117-119** �
32-37 - 1 - ic - HIV Advisory Committee - Pages 110, 117**
32-37 - 1 - ld - Employee training - Pages 110, 118**
32-37 - 1 - lf - Immunizations - Pages 110, 118 �
32-37 - 1 - lg - Mantoux - Pages 110, 118
32-37 - 1 - lh - Hep B vaccination - Pages 110, 119
32-37 - 2 - 2a - Organize metro epi - Pages 110, 119** �
32-37 - 2 - 2b - Planning/implementing alternative strategies - 110,
119
32-37 - 1 - la - Community Clinic funding - Pages 110, 120
34-35 - 2 - 2a - Evaluate needle distribution - Pages 110, 120** �
32 - 1 - la - STD testing - Pages 110, 121
32 - 1 - lb - Health education - Pages 110, 121**
32 - 1 - lc - High risk HIV counseling - Pages 110, 121** �
34-35 - 2 - 2a - HIV testing & counseling - Pages 110, 122**
34-35 - 2 - 2b - Enhanced HIV services - Pages 110, 122**
"" " 2c - HIV seroprevalence studies - Pages 110, 122
"" " 2d - Health education - Pages 110, 122-123** 1
"" " 2e - Onsite HIV testing & counseling - Pages 110, 123**
"" " 2f - Prevention services at gay bars - Pages 110, 123**
33, 37 - 3 - 3a - Immunizations - Pages 110, 123** ,
"" " 3b - WIC immunizations - Pages 110, 124**
"" " 3c - Provision of free vaccine - Pages 110, 124**
"" " 3d - Hep B prevention - Pages 110, 124** �
"" '� 3e - Immunization health education - Pages 110, 125**
"" " 3f - Immunization record review - Pages 110, 125**
"" " 3g - Refugee health screening - Pages 110, 125**
���� �� 3h - Public health surveillance "" "" �
3i - Immunization program evaluation - Pages 110, 126
"" " 3j - Hep B Coalition - Pages 110, 126**
36 - 4 - 4a - TB screening - Pages 110, 126** �
" " 4b - TB treatment - "" "" ""
"" " 4c - Public health surveillance "" ""
���� �� ���� ����** ,
���� �� 4d - Child care staff education
4e - Refugee health screening - Pages 110, 126**
"" " 4f - TB home visits - Pages 110, 126-127
Bmerqency Medical Care �
2-5 - 2 - 2a - EMS funding - Pages 27, 33
�
** Also falls under Health Promotion Category
�
�
212 r
�
�
1992-95 RAMSBY COUNTY-ST. PAUL CHS PLAN INDBX OF MBTHODS
,
Environmental Health
� 16, 22, 23 - 1 = la - Industrial haz waste licensinq - Pages 72-73, 78
"" "" " " lb - Industrial haz waste investigation -
���� ���� ����
"" "" " 2 2a - Problem waste public ed. - Pages 72-73, 78-79**
16 - 3 - 3a - Well water testing - Pages 72-73, 79
, " " 3b - Lake Jane water testing - "" "�� °��
16, 22, 23 - 4 - 4a - Recycling - Pages 72-73, 80
16, 22, 23 - 5 - 5a - Solid waste regulation - Pages 72-73, 80-81
� 18 - 6 - 6a - Food protection - Pages 72-73, 81
19, 21 - 7 - 7a - MCIIA - Pages 72-73, 81-82**
24 - 8 - 8a - Lodging facilities - Pages 72-73, 82
17, 24 - 9 - 9a - Public health nuisances - Pages 72-73, 82-83
� 24 - 1 - la - Housing code - Pages 72-73, 84
" " lb - Unsafe buildings - "" "" ""
" " lc - Truth in Sale of Housinq - "" ""
� " " ld - I&R - Pages 72-73, 85**
18, 19 - 2 - 2a - Food establishment inspections - Pages 72-73, 85
"" "" "" 2b - Food manager training - Pages 72-73, 85**
"" "" "" 2c - Day care food inspection - Pages 72-73, 85-86**
� "" "" "" 2d - Itinerant food inspection - "" "" , 86**
17 - 3 - 3a - Lead inspections - Pages 72-73, 86**
"" "" 3b - Lead abatement - "" "�� ����
� 16, 19, 20, 21 - 4 - 4a - Septic system ordinance - Pages 72-73, 87**
"" "" "" "" " 4b - Mandatory water testing - "" ���� ��**
"" "" "" "" " 4c - Noise ordinance investigation "" ���� ����
, ���� ���� ���� ���� �� 4d - MCIAA - ���� ���� �����t
"" "" "" "" " 4e - Hazardous waste - Pages 72-73, 87-88
"" "" "" "" " 4f - Sick buildinqs - Pages 72-73, 88**
"" "" "" "" " 4g - Air pollution - "" "" �'**
� "" "" "" "" " 4h - Environmental Health Ed "" ""**
"" "" "" "" " 4i - I&R - Paqes 72-73, 88**
� Family Health
� 6-15 - 1 - la - Community coordination - Pages 39-40, 54**
lb - Child abuse - Pages 39-40, 54
„" „ lc - Child protection collaboration - Pages 39-40, 54**
���� ��
"" " ld - Planning & implementation of alternatives - Pages
� 39-40, 55-56**
8, 9, 11, 12 - 2 - 2a - Nursing services - Pages 39-40, 55
"" "" "" " 2b - Public Health information - "" ""**
� "" "" "" " 2c - Teen pregnancy education _ "" , 56**
"" "" "" " 2d - Family Health guidelines "" ""
13 - 3 - 3a - Assure extended hour care - Pages 39-40, 56
" " 3b - Nursinq services - Pages 39-40, 56
, " " 3c - Screening and referral - Paqes 39-40, 56
" " 3d - Respiratory problems - "" "" "�� ����
" " 3e - DD training - Pages 39-40, 57
� ** Also falls under Health Promotion Cateqory
` 213
�
�
1992-95 RAMSBY COUNTY-ST. PAUL CHS PLAN INDBX OF MBTHODS
�
Family Health (cont. ) �
14 - 4 - 4a - SIDS in-home services "" ""
7 - 5 - 5a - Day care consultation "" ""** �
�� " 5b - Lead program - Pages 39-40, 58**
6, 8-15 - 1 - la - Community clinic funding - Pages 39-40, 59
6, 8, 11, 12 - 1 - la - Health Start/MCH funding - Pages 39-40, 60 �
���� ���� ���� �� " lb - Infant Mortality Task Force "" "" ""**
���� ���� ���� �� " lc - Infant Mortality Project "" "" ""**
7 - 2 - 2a - Day care inspection - Pages 39-40, 61
" " 2b - Swimming pool inspection "" "" �
"" "" 2c - Foodborne illness "" ""
"" "" 2d - Food manager training - Pages 39-40, 62**
"" "" 2e - Room and boarding facilities - Pages 39-40, 62 ,
9 - 3 - 3a - Family planning methods - Pages 39-40, 62
�� �� 3b - Pregnancy testing "" "" ""
�� �� 3c - MCH Grant funded outreach "" "" 63**
7 - 4 - 4a - Blood lead testing - Pages 39-40, 63** ,
�� �� 4b - Additional screening sites "" "" "**
"" " 4c - Lead dwelling analysis "" "" ""
��" " 4d - Lead lobbying efforts "" "" ""** �
�� " 4e - Technical assistance "" "" "**"
�� �� 4f - Lead education "" "" "**"
8, 9 - 5 - 5a - MCH funding for school-based clinics - Pages 39-40, ,
64**
�� �� " 5b - Family planning & STD testing for adolescents - Pages
39-40, 64 �
Home Health Care
40, 1 - la - Screening and referral - Pages 142, 147 �
"" 2 - 2a - Nursing services - Pages 142, 147
"" " 2b - Short-hour care - Pages 142, 148 �
"" " 2c - Living at Home/Block Nurse - Pages 142, 148
40, 41 - 3 - 3a - Community coordination - Pages 142, 148-149
���� ���� �� 3b - Planning and implmentation of alternative strategies
- Pages 142, 150-151 �
���� ���� �� 3c - SAI L - Pages 14 2, 151
40 - 1 - la - Community Clinic funding - Pages 142, 152
���� ���� ���� ���� ���� �
lb - Flu shots & referral
��" "" lc - Public Health Housing Program "" "" ""
���� ���� ld - Elderly health maintenence "" "" ""**
** Also falls under Health Promotion Category �
�
214 ,
�
�
1992-1995 RAMSBY COUNTY-ST. PAUL CHS PLAN SOlIIKARY
� (Note: Due to the complexity of this Plan, it was impossible to
include the required information on one page as requested. )
� The St. Paul-Ramsey County Community Health Services Advisory
Committee and staff from the St. Paul Division of Public Health and
the Ramsey County Public Health Department completed a broad-based
, Community Assessment and developed a list of fifty Priority Public
Health Problems and Goals in 1990 and 1991. These Problems and Goals
are listed below:
� PROBLBM 1: Increasin number of re rts f hil
g po o c d abuse, domestic
abuse, and abuse of the elderly and disabled**
� GOAL 1: To advocate and work towards a society free of child
abuse, domestic abuse, and abuse of the elderly and
disabled
� PROBLEM 2: High number of deaths, disabilities, and Years of
Potential Productive Life Lost associated with motor
, vehicle accidents
GOAL 2: To reduce to a minimum the number of deaths, disabilities,
and years of potential productive life lost associated
with motor vehicle accidents
� PROBLEM 3: High occurrence of deaths and disabilities associated with
childhood/adolescent unintentional injuries
� GOAL 3: To reduce to a minimum the incidence of deaths and
disabilities due to unintentional injuries in persons of
all ages
� PROBLEM 4 : High incidence of deaths and disabilities due to
unintentional injuries in persons of all ages, and persons
between the ages of 15-24 in particular
� GOAL 4 : To reduce to a minimum the incidence of deaths and
disabilities due to unintentional injuries in persons of
all ages
� PROBLEM 5: Increasing incidence of suicide and homicide deaths among
people ages 15-24
GOAL 5: To reduce the incidence of suicide and homicide deaths
, among people ages 15-24
� ** Identified as one of thirteen Highest Priority Problems by St.
Paul-Ramsey County Community Health Services Advisory Committee
,
,
, 215
�
�
1992-1995 RAMSBY COUNTY-ST. PAUL CHS PLAN SUI�II�ARY (cont. )
hil r n in ,
PROBLSM 6: High occurrence of abuse and neqlect of c d e be g
born to large numbers of single women and/or adolescents,
as well as parents who are actively abusinq/addicted to �
chemicals **
GOAL 6: To reduce to a minimum the incidence of births to
adolescents and/or parents who are actively abusing/ �
addicted to chemicals, and to advocate and work towards a
society standard free of child and domestic abuse
PROBLEM 7: Hiqh number of children at risk for injury and illness due �
to various day-care and school safety and hygiene issues,
i.e. food safety, communicable disease, lead, and
structural/equipment concerns ** �
GOAL 7: To eliminate the risk for injury and illness due to
various day-care and school safety and hygiene issues
PROBLBM 8: Occurrence of late or no entry into prenatal care, �
particularly in communities of color **
GOAL 8: To develop universal understanding of the importance of �
early prenatal care, and to assure equal and fully
adequate access to prenatal care for all residents of
Ramsey County
PROBLBM 9: High rate of unintended pregnancy among teens ** �
GOAL 9: To reduce to a minimum the incidence of unintended
pregnancy among teens �
PROBLEM 10: Lack of parenting skills for child care/parenting
GOAL 10: To foster and assure positive parenting skills for child
care/parenting �
PROBLEM 11: High prevalence of high risk & premature births
GOAL 11: To reduce to a minimum the incidence of high risk & �
premature births
PROBLEM 12: Increasing incidence of low birthweight births among �
Southeast Asians; high incidence of low birthweight births
among Blacks and American Indians; high birth rates among
Southeast Asian and Black teenagers �
GOAL 12 : To develop universal understanding of the importance of
early prenatal care, and to assure equal and fully
adequate access to prenatal care and family planning �
services for all residents of Ramsey County
** Identified as one of thirteen Hi hest Priorit Problems b St. ,
9 Y Y
Paul-Ramsey County Community Health Services Advisory Committee
,
216 �
�
�
1992-1995 RAMS$Y COUNTY-ST. PAUL CHS PLAN SUI�II�IARY (cont. )
�
PROBLEM 13: Prevalence of chronic illness/disabilities associated
with genetic/metabolic disorders, developmental delay,
� injury
GOAL 13: To reduce to a minimum the incidence of chronic illness/
disabilities associated with genetic/metabolic disorders,
, developmental delay, and injury
PROBLEM 14 : High infant death rate among high risk groups; incidence
� of Sudden Infant Death Syndrome deaths
GOAL 14 : To develop universal understanding of the importance of
early prenatal care, and to assure equal and fully
adequate access to prenatal, postpartum and pediatric care
� for all residents of Ramsey County
PROBLEM 15: Prevalence of pediatric asthma
� GOAL 15: To reduce the incidence of pediatric asthma
PROBLBM 16: Prevalence of qroundwater, surface water, soil, and air
� pollution **
GOAL 16: To assure safe, clean air and water and to reduce risks
associated with exposures to hazardous substances for all
residents of Ramsey County
, PROBLEM 17: Lead-based paints: ingestion by children, improper
removal and disposal•, incidence of lead poisoning cases
� in Ramsey County children
GOAL 17 : To eliminate exposure of Ramsey County children to lead
and to assure proper removal and disposal
� PROBLEM 18: Occurrence of bacteria, viruses, pesticides, and chemicals
in food resultinq in illness and/or toxic
exposures
� GOAL 18: To assure a food supply free of harmful bacteria, viruses,
pesticides, and chemicals for all Ramsey County
residents
, PROBLEM 19: Occurrence of exposure to second-hand smoke in public
facilities due in part to lack of awareness/enforcement
of the Minnesota Clean Indoor Air Act
, GOAL 19: To eliminate exposure to second-hand smoke in public
facilities and to assure awareness/enforcement of the
Minnesota Clean Indoor Air Act
�
** Identified as one of thirteen Highest Priority Problems by St.
� Paul-Ramsey County Community Health Services Advisory Committee
,
, 217
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1992-1995 RAI�ISBY COUNTY-ST. PAUL CHS PLAN SU1�II�ARY (cont. )
�
PROBLEM 20: Higher than average radon concentrations in Ramsey County
homes �
GOAL 20: To eliminate harmful residential radon exposures for all
Ramsey County residents
PROBLEM 21: Occurrence of sick building syndrome ,
GOAL 21: To assure safe building environments relative to air
quality, heating, cooling, lighting, etc. for all persons
working in Ramsey County �
PROBLEM 22: Workers at risk from improper disposal of household
hazardous waste, infectious wastes, illegal drug labs,
explosives/ammunitions, etc. ; garbage haulers and Solid �
Waste facility operators
GOAL 22: To assure worker safety among waste haulers and solid
waste facility operators �
PROBLEM 23: Instances of improper disposal of household and
industrial hazardous waste �
GOAL 23: To eliminate improper disposal of household and industrial
hazardous waste
PROBLEM 24 : Increasing amount of unsafe and poor quality housing ,
GOAL 24 : To eliminate threats to personal health caused by unsafe
and poor quality housing
PROBLEM 25: Increasing numbers of inentally ill individuals livinq in �
the community who need assistance in medication
manaqement and daily livinq tasks **
GOAL 25: To assure assistance in medication management and daily �
livinq tasks for mentally ill individuals living in the
community
PROBLEM 26: Prevalence of chronic illness/impairment in children and �
adults associated with Fetal Alcohol Syndrome and other
drug abuse, increasing prevalence of drug-attached �
newborns and cocaine babies
GOAL 26: To eliminate the incidence of chronic illness/impairment
in children and adults associated with fetal alcohol
syndrome and other druq abuse, and drug-attached newborns �
and cocaine babies
** Identified as one of thirteen Highest Priority Problems by St. �
Paul-Ramsey County Community Health Services Advisory Committee
�
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1992-1995 RAMSBY COUNTY-ST. PAUL CHS PLAN StJI�IIKARY (cont. )
�
PROBLEM 27: Prevalence of chronic illness/disabilities associated
� with alcohol, other chemical and IV drug abuse
GOAL 27: To reduce to a minimum the incidence of alcohol, other
chemical and IV drug abuse and to assure services to
address chronic illness and disabilities associated with
� abuse of these chemicals
PROBLEM 28: Increasing prevalence of chronic illness/disabilities
� associated with smoking/tobacco use in teens
GOAL 28: To eliminate smoking/tobacco use in teens and to assure
services to address chronic illness/disabilities
associated with these practices
�
PROBLEM 29: Increasing prevalence of psychiatric and chemical
� dependency problems in non-English speaking populations
GOAL 29: To reduce the incidence of psychiatric and chemical
� dependency problems in non-English speaking populations,
and to assure cultural- and language-appropriate services
to these populations
� PROBLEM 30: Increasing prevalence of automobile driving under the
influence of alcohol and various chemicals
GOAL 30: To eliminate automobile driving under the influence of
� alcohol and various chemicals
PROBLEM 31: Mental health problems and chemical abuse/dependence
� among the elderly
GOAL 31: To reduce the incidence of inental health problems and
chemical abuse/dependence amonq the elderly and to assure
appropriate services to address these problems in this
� population
PROBLSM 32: Increasinq prevalence of all sezually transmitted
� diseases **
GOAL 32: To reduce to a minimum the incidence of all sexually
transmitted diseases
� PROBLEM 33: Prevalence of vaccine-preventable diseases, includinq
measles and hepatitis **
GOAL 33: To eliminate the incidence of vaccine-preventable
� diseases, including measles and hepatitis
** Identified as one of thirteen Hiqhest Priority Problems by St.
� Paul-Ramsey County Community Health Services Advisory Committee
,
� 219
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1992-1995 RAMSBY COUNTY-ST. PAUL CHS PLAN StJl�II�1ARY (cont. )
• 'nf ion• dis ro ortionate �
PROBLEM 34 . Increasing prevalence of HIV i ect , p p
prevalence among Black and Hispanic populations
GOAL 34: To eliminate the spread of HIV infection among all �
populations and to assure adequate and culturally
appropriate services for all persons infected with the
virus �
PROBLEM 35: Numbers of adolescent males at hiqh risk for HIV
infection i
GOAL 35: To eliminate the spread of HIV infection among all S
populations and to assure adequate and culturally
appropriate services for all persons infected with the
virus �
PROBLEM 36: Existence of potential for spread of communicable
disease by sick workers, including but not limited to �
spread of Hepatitis B from accidental needle sticks, to
health care workers, day care providers, first
responders, solid waste handlers, etc. �
GOAL 36: To eliminate the spread of vaccine-preventable diseases by
sick workers and to reduce to a minimum the spread of all
other communicable diseases by sick workers
PROBLEM 37: Increasing prevalence of Hepatitis B carriers �
GOAL 37: To eliminate the incidence of vaccine-preventable �
diseases, including measles and hepatitis
PROBLBM 38: Lack of access to health care, particularly amonq workinq
poor, and children living in poverty ** ,
GOAL 38: To assure access to health care for all residents of
Ramsey County
PROBLEM 39: High prevalence of chronic disease in minority and �
low-income populations
GOAL 39: To reduce the incidence of chronic disease in minority �
and low-income populations
** Identified as one of thirteen Hiqhest Priority Problems by St. �
Paul-Ramsey County Community Health Services Advisory Committee
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1992-1995 RAMSBY COUNTY-ST. PAUL CHS PLAN SUl�II�1ARY (cont. )
� f r lf-care amon rsons 85+
PROBLSM 40: Hiqh rate of inability o se q pe ,
. the fastest qrowing age cohort in the population;
, inability/difficulty of elderly to perfor� Activities of
Daily Livinq (ADLs) **
GOAL 40: To increase to a maximum the ability of the elderly to
� perform ADLs and to assure access to needed services for
this population
� PROBLBM 41: Hiqh rate of need for caregiver support for h�ebound
elderly **
GOAL 41: To assure caregiver support services for persons caring
for homebound elderly
� PROBLSM 42: Increasing prevalence of chronic diseases due to
lifestyle choices **
, GOAL 42: To eliminate lifestyle choices which have been
demonstrated to cause chronic disease, and to assure
services to address chronic diseases
� PROBLEM 43: High incidence of malignant neoplasm deaths, including
increasing rate of lung cancer, which is the leading
cause of cancer-related death in Minnesota, and
� increasing incidence rates of new cancers of the breast,
lung, cervix and the colon/rectum
GOAL 43: To reduce the incidence of malignant neoplasm deaths
� PR BLEM 44 : Prevalence of chronic illness/disabilities associated
0
with poor nutrition
� PROBLEM 45: Prevalence of chronic disease associated with obesity
, PROBLEM 46: Inadequate quality of food, leadinq to prevalence of
chronic disease and malnutrition
PROBLEM 47: Dependence of populations/individuals on food shelves/
, commodities (poor quality, uneven supply) , leading to
prevalence of chronic disease and malnutrition; high
prevalence of residents of public housing skipping meals
and relying on food shelves/commodities for food
, GOAL 44-47: To assure adequate food supplies, foster appropriate food
choices, and reduce the incidence of obesity among all
residents of Ramsey County
, �* Identified as one of thirteen Highest Priority Problems by St.
Paul-Ramsey County Community Health Services Advisory Committee
,
,
, 221
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1992-1995 RAMSBY COUNTY-ST. PAUL CHS PLAN Sil1�tARY (cont. )
PR BLEM 48: Hi h r v 1 n �
0 q p e a e ce of gum disease in general population
PROBLEM 49: High prevalence of dental caries in low-income people ,
PROBLEM 50: Increasing incidence of baby bottle caries
GOAL 48-50: To eliminate the incidence of gwa disease in the general �
population, to reduce to a minimum the incidence of
dental caries and assure access to dental care for all
residents of Ramsey County, and to eliminate the �
incidence of baby bottle caries
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INDIAN HEALTH GR;ANT
� FOR
� ST. PAUL AND SUBURBAN RAMSEY COUNTY
' AMERICAN INDIANS
1992-1993
�
�
� Submitted by:
THE ST. PAUL DIVISION OF PUBLIC HEALTH
� 555 Cedar Street
St. Paul, MN 55101
�
� Amount Requested:
Total funds for two year period: $242,636
Request for year 1: $119,647
� Request for year 2: $122,989
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Indian Health Grant
Table of Contents �
MINNESOTA DEPARTMENT OF HEALTH FORMS �
FaceSheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
1'roject Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226 �
Evidence of �ompliance - Workers' Compensation . . . . . . . . . . . . . . . . . . . . . 227
APPLICATION NARRATIVE �
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
'
Problem Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Goals, abjectives, Methods and Evaluations �
High Risk Births . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Chronic Disease Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
DentalHealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 �
Breast/Cervical Cancer, and Unintended Pregnancies . . . . . . . . . . . . . . . . . . 239
Menial I-:�alth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 �
Budget Justification
1942 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245 �
1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
APPENDIX �
Data on American Indians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
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� MINNESOTA DEPARTMENT OF HEALTH FORMS
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MINNESOTA DEPARTMENT OF HEALTH
� Face Sheet
' Grant Application For
(1) Indian Health Grant
Name of Grant
� 2 APPLICANT AGENCY with which contract is to be executed
t,egal Name Address Phone (include area code)
� City of St. Paul, 555 Cedar Street (612)292-7712
Division of Public Health St. Paul, MN 55101
� 3 DIRECTOR OF APPLICANT AGENCY
Name/T'uk Address Phone (include area code)
Katherine Cairns 555 Cedar Street (612)292-7712
Public Health Svcs. Mgr. St. Paul, MN 55101
-� 4 FISCAL MANAGEMENT OFFICER OF APPLICANT AGENCY
Name/Title Address Phone(includc area code)
1 Katherine Cairns 555 Cedar Street (612)292-7712
Public Health Svcs. Mgr. St. Paul, riN 55101
S OPERATTNG AGENCY if different from numbcr 2
� Name/Title Address Phone(include azea code)
American Indian Health Care 245 East Sixth Street, St: Paul (612)293-0233
, 6 CONTAGT PER:ON FOR OPERATING AGENCY it different[rom number 3
Name/Title Address Phone(include area code)
P•lichael Arfsten 245 East Sixth Street, Suite 499 (612)293-0233
� Executive Director St. Paul, MN 55101
7 CONTAGT PERSON FOR FURTHER INFORMATION ON APPLICATION if different from number 6
' Name/Title Address P6one(incldue azea code)
Diane Holmgren 555 Cedar Street (612)292-7712
Health ad�ainistration Mgr. St. Paul, MN 55101
� (8) COPIES OF THIS APPLICATION HAVE BEEN SENT TO THE FOLLOWING REVIEW AGENCIES:
AGENCY TYPE AGENCY NAME(S) Metropolitan Council Date sent
� Regional Developmcnt
Commission(s) 230 East Fifth Street, St. Paul, MN 55101 9/9/91
� Community Health Board(s)
--N/A if the Board is
the Applicant--
� (9) I certify that thc informaGon contained herein is true and a ate to the best of my knowledge and that I submit this
application on behalf of the applicant agenry.
� � .
Signatwe of Director of Applicant Agency:
TiUe: D���1�c Health Services ManaQer Date:�'�I'
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HE-01274-02(3/15/91) 225
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MINNFSOTA DEPARTMENT OF HEAL'i'H
PRO�'ECT INFORMATiON �
(1) Indian Health Grant
(Namo of Grant) '
(2) PROJECT INFORMATION
APPLICAI�T AGENCY
�
, City of St. Paul, Division of Public Health �
B�GINMNG DATE END DATE PROJECT FUNDS REQUESTED
Jan•uary 1 , 1992 December 31, 1993 T�� Yeaz 1, Yeaz 2
$242 636 $119,647/$122,989 �
SERVICE ARFA (City�Couny, or Counties) LOCAL MATCH PROVIDED
. Ramsey County Total Year � Year 2
i
MN TAX I.D. �
802-5095 �
FED.I.D. � (if appGcable)
� 41-6005521 �
(3) NON-PROflT STATUS: �
SO1.C3 copy attac6ed: Yes Not AppGcable X
(4) FVIDENGE OF WORKERS' COMPENS,a►'i'ic�N INSURANCE: �
Attac6ed: Yea No Not Applicable_�
(� The'ag�ocy has a certif►cate from the Comm�ssioner of Human Rights, pursuant to Minnesota Statutes, '
. Sedioa 363.0?3:
Attac6ed: Yea No X �
Not AppGcable because: a. Total contrad is SS0,000 ot less
b. Agenry has ZO or fewer[ull-time empbyees
c.�_Uaits of local government �
d Indian reservations '
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� EVZDENCE OF COMPLIANCE
State law forbids the Commissioner of Health fron enterinq into
any contract until the Commissioner receives acceptable evidence
' of compliance with workers' compensation insurance coverage
requirements from the contractor. Tfie. exception to this
requirement is a self-employed contractor who has no employees.
� An employee, as defined by Minn. Stat. 176. 011, subd. 9 , is any
person who performs services for another for hire, including
ninors and family members. � •
iIf you do not fall within the exception and you wish to enter
into a contract with the Commissioner of Health, you can furnish
acceptable evidence of compliance with workers' compensation
� coverage in any one of the following four ways:
I . Attach a certificate of insurance (supplied by you workers'
� compensation carrier) to this Exhibit; or
II. If you are self-insured, attached a written order from the
I Minnesota tommissioner of Commerce allowing you to self- •
insure to this Exhibit; or
III. If you are self-insured and you are a state agency or a
� municipal subdivision of the state, pursuant to Minn. .
Stat. 176. 181, subd. 2 , and are not required to obtain a
written order from the Commissioner of Commerce, circle this
� entire item and sign and date the for� below in the space �
provided; or
ZV. Fill in the information for each ite'm below and siqn in the
� space provided:
A. Name of Contractor's insurance carrier: �
� � � �
B. Address of Contractor's insurance carrier: �
�
� c. Contractor's insurance policy number:
� D. I affirm that all the employees o�
(Contractor's Name)
are covered by the workers'
compensation insurance policy listed a ve.
� � •
Signed by:
IT itle: Public Health Services Manager
Date: �"'i��t�
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' Indian Health Grant
Saint Paul Division of Public Health
' 1992-1993
�
� The health care environment for American Indians residing in St. Paul and
suburban Ramsey County has undergone extensive changes and disruption
/ during the past year, from late 1990 to mid 1991. The closing of a clinic in
� St. Paul which focused on serving American Indians left many individuals
without a regular, culturally sensitive source of health care. A new health
' clinic targeted to American Indians is cunently being established in St. Paul
by the American Indian Health Care Association to provide a variety of
� health services to this population. This proposal addresses various
components which are felt to be critical to rebuilding and improving health
resources and the health status of Ramsey County American Indians.
�
� A. PROBL.EM STATEMENT
An examination of population data using the 1990 census data reveals
� significant American Indian populations in five Health Planning Areas
(HPAs) in Ramsey County including:
, • Phalen Park with 479 American Indians.
• Dayton's Bluff with 421 American Indians
� • Thomas-Dale with 346 American Indians
• Rice Street with 336 American Indians
• Riverview with 295 American Indians
�
Statisticians, both nationally and locally, have commented that the 1990
' census may represent an under-reporting of inetropolitan minorities,
including American Indians. Thus, it is safe to conclude that the 4,509
American Indians identified in Ramsey County from the 1990 census (3,697
, of which live within the City of St. Paul), represents a minimum number
rather than an actual count.
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data is not et available it is im ortant to note that �
Although current y , p
according to 1980 census data, 251 out of 681 American Indian households
in Saint Paul were receiving public assistance. This indicates that a �
significant percent (36.9%) of American Indian households live in poverty.
Poverty frequently is an important contributing factor to lack of access to �
needed health care.
Specific health problems which have been identified among American �
Indians in Ramsey County include the following (using primarily 1988 data,
the most recent available): �
• 38% of pregnant American Indian teens began prenatal care in the
�rst trimester (St. Paul rate: 25%, MN rate: 47%); t
• 40% of all pregnant American Indian women began prenatal care �
in first trimester (St. Paul rate: 36%, MN rate: 49%, State goal:
91%);
• 7.7% of American Indian births were low birth weight (St. Pau
1 �
rate: 10.6%, MN rate: 6%); �
• 18% of 1988 American Indian births were to teenage (<20 years)
women (St. Paul rate: 17%, MN rate:21%); �
• Over 60% of all deaths in Ramsey County residents were due to �
chronic diseases including heart disease, malignant neoplasms and
cerebrovascular disease;
' n Indian have a low incidence of cancer the �
• Although America , Y
have the lowest cancer survival rate of all groups (34%)
�
• Over 20% of Ramsey County adults were at risk for at least one
chronic disease risk factor (hypertension, obesity, smoking, acute �
drinking);
• American Indian children and adults have received inadequate �
dental care primarily due to cost and access problems in Ramsey
County. �
230 ,
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' Re resentatives from various American Indian or anizations and a encies in
p g g
Ramsey County were invited to a focus session to discuss the health needs
' of the Indian population. The individuals who attended all agreed that
there were many health needs in the Indian community. It was felt that a
� lack of adequate transportation was an overriding factor leading to
decreased health status, and is one of the biggest baniers to access and
receipt of adequate health care.
�
The focus group also felt that based on the health of the Indian population,
� and other factors such as transportation and accessibility, the following
services are critically needed:
� • prenatal care
• chronic disease education, screening and treatment
1 • dental care
• cervical and breast cancer screening and education
• family planning and pregnancy testing
� • mental health referrals and linkages
It was emphasized that to ensure the best outcome, services should be
tprovided in a culturally appropriate manner and environment to the greatest
extent possible. Additionally, the group indicated that traditional healing
� practices need to be acknowledged, and provisions made for referrals to
Elders and Medicine Men when requested and appropriate.
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B GOAVS� OB iECTNES, MFTHODS AND EVALUATIONS
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To address these specific health problems, a series of public health goals ,
and objectives have been identi�ed.
�
GOAL 1: To reduce the rate of high risk births among Ramsey County
American Indian women. �
Ob�ect
ive lA: �
To increase the percent of pregnant Ramsey County American Indian �
women initiating prenatal care in the first trimester from 40% to 52%
by December 31, 1993. �
Objective 1B:
To increase the number of pregnant American Indian women
,
receiving prenatal nutrition counseling and supplemental nutritious �
food through the W.I.C. Program from �$* to 40* by December 31,
1993. (*1'hese numbers are probably underestimated as at this time
W.I.C. determines ethnicity by visual identification only.) �
Objective 1C: �
To reduce the prevalence of chemical abuse (alcohol, drugs, smoking)
among pregnant American Indian women in Ramsey County during �
the prenatal care period through 1993.
�
Methods:
ist in ident' 'n re nant American Indian ,
- Outreach worker vv�ll ass � g p g
women and ensure prenatal services are initiated. An estimated 40
pregnant women annually will be reached. �
- Transportation and child care services may be provided/arranged to �
232 �
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, enable pregnant American Indian women in Ramsey County to
attend prenatal care appointments.
� - u reach efforts referral s stem and follow-u will be further
Ot / y p
developed to target pregnant Ramsey County American Indian
' women for W.I.C. Program participation.
� - Substance abuse status, determination, counseling and intervention
will be conducted with all Ramsey County American Indian clients
receiving prenatal services. Clients may be referred to other
� providers for more comprehensive services of this nature.
� - Services and education will address the need for improved health,
decreased/eliminated substance abuse, improved nutrition and early
prenatal care.
� _ n nt American Indian women ma be
Support groups for preg a y
established to assist in reducing substance abuse before, during and
� after pregnancy.
f - Appropriate reimbursement will be secured from l��zdical
Assistance and the Prenatal Care Initiative when applicable.
� - Referrals will be made to Elders and Medicine Men for traditional
healing measures when requested and appropriate.
�
Evaluation:
1
Subgrantee(s) of the St. Paul Division of Public Health who provide
� components of service to American Indians in Ramsey County will be
required to have an annual contract which indicates specific
performance expectations, service delivery goals, reporting
, requirements, and quality assurance requirements. Quarterly
reimbursement will be released after receipt of designated reports and
' review of progress toward goals and objectives. Data will be analyzed
in order �to assess program effectiveness and make program
changes/modifications as needed.
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For the project goal, the following indicators will be evaluated:
� � �
- rate of Ramsey County pregnant American Indian women
initiating prenatal care in the first trimester for the years 1990 ■
and 1991. �
- percent of pregnant American Indian women within the �
funded project who initiate prenatal care in the first trimester
for the years 1992 and 1993. �
- number of pregnant American Indian women from Ramsey
County served by the project. '
- number of pregnant American Indian women from Ramsey ,
County enrolled in the W.I.C. Program.
- number of American Indian women ages 15 to 44 from ,
Ramsey County participating in substance abuse
counseling/support services sponsored by the project, ,and �
identification of the number of women who self-report to
remaining chemical-free throughout their pregnancy.
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' GOAL 2: To reduce the rates of chronic diseases commonly found in
American Indians.
'
' Objective 2A: -
To continue to establish baseline data and identify rates of diabetes,
� hypertension, elevated serum cholesterol, smoking and alcohol abuse
among Ramsey County American Indian youth and adults (ages 15 to
64) participating in screenings through this project by December 31,
' 1993. �
, Objective 2B:
To conduct health screening for diabetes, cholesterol, hypertension,
, smoking and alcohol abuse and referral for treatment for 800
American Indian youth and adults (ages 15 to 64) in Ramsey County
, by December 31, 1993.
` Methods:
� - Epidemiological tracking tool will be used to document the number
of persons screened for the specified chronic diseases and the rates
of each specific chronic disease within the population group.
,
- Division of Public Health will seek summary data from the
� Minnesota Department of Health, the Department of Human
Services and other sources on the morbidity and mortality rates for
speci�c chronic diseases among Ramsey County American Indians.
�
- Community-based health screening targeted at Ramsey County
, American Indians will be conducted with testing/assessment for �
diabetes, cholesterol, hypertension, smoking and alcohol use.
, - Referral of 100% of individuals testing at risk for the specific
conditions will be made to their health care provider and will be
documented in writing for follow-up and quality assurance purposes.
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- Transportation may be provided to some individuals identified
through screening as being at risk to ensure that follow-up �
appointments can be kept.
- Appropriate reimbursement will be secured from Medical '
Assistance and other insurance programs when applicable.
- Referrals will be made to Elders and Medicine Men for traditional �
healing measures when requested and appropriate.
�
Evaluation: ,
Subgrantee(s) of the St. Paul Division of Public Health who provide
components of service to American Indians in Ramsey County will �
be required to have an annual contract which indicates specific
performance expectations, service delivery goals, reporting
requirements, and quality assurance requirements. Quarterly '
reimbursement will be released after receipt of designated reports
and review of progress toward goals and objectives. Data will be �
analyzed in order to assess program effectiveness and make
program changes/modifications as needed.
�
For this project goal, the following indicators will be evaluated:
- revalence rate of diabetes, elevated serum cholesterol, �
P
hypertension, smoking and alcohol abuse among Ramsey County
American Indians screened through this project. ,
- number of Ramsey County American Indians screened at �
community-based health screenings for specified chronic disease
indicators.
h '
- number of persons referred for each spec�fic condition and t e
percent of individuals attending at least one treatment appointment �
with their primary health care provider (for diabetes, cholesterol,
hypertension) or support group (for smoking, alcohol abuse).
�
236 �
�
' .
' GOAL 3: To improve the dental health of Ramsey County's American
Indian children and adults.
�
� Objective 3A:
To conduct dental health education to at least 300 Ramsey County
� American Indian children (ages 3 to 17) annually through 1993.
, Objective 3B:
To provide information, refenals and transportation for preventive
' and restorative dental care to Ramsey County American Indians to
decrease the rates of dental disease.
r
Methods:
' - Dental care, education and outreach services will be targeted to
American Indians in Ramsey County.
'
� - Health education on dental topics will be provided through group
� education in child care centers, family day care homes, schools,
religious institutions and at community gatherings.
� - Services provided will be documented in client records and
extracted for quarterly reports and quality assurance audits.
' - Transportation may be provided to help ensure that people are able
to attend scheduled dental appointments.
� _ fr m Medical Assistance when
Reimbursement will be sought o
� appropriate.
- Referrals will be made to Elders and Medicine Men for traditional
� healing measures when requested and appropriate.
�
� 237
'
'
Evaluation: '
Subgrantee(s) of the St. Paul Division of Public Health who provide '
components of service to American Indians in Ramsey County will
be reyuired to have an annual contract which indicates specific �
performance expectations, sernce del�very goals, reporting
requirements, and quality assurance requirements. Quarterly
reimbursement will be released after receipt of designated reports �
and review of progress toward goals and objectives. Data will be
analyzed in order to assess program effectiveness and make
program changes/modifications as needed. ,
For this project goal, the following indicators will be evaluated:
,
- revalence of dental caries amon American Indians in Ramsey r
P g
. County served by this project.
_ i n Indians rovided with dental '
number of Ramsey County Amer ca p
education, referrals and transportation assistance. ,
. �
�
,
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�
238 �
,
1 r-���3
9
' Goal 4: To reduce the rates of breast and cervical cancer, and unintended
pregnancies in American Indian women.
� 'v 4A:
Ob�ecti e
� To provide education to 600 Rainsey County American Indian women
regarding the importance of regular screening and examinations for
� cervical and breast cancer by December 31, 1993.
' Objective 4B:
To provide family planning education and services/refenals to 400
' Ramsey County American Indian women by December 31, 1993.
Objective 4C:
'
To assist 60 American Indian women in Ramsey County in receiving
' low/reduced cost mammography screening and referral for follow-
up/treatment by December 31, 1993.
'
Methods:
� - Health education on the importance of screening for early detection
of cervical and breast cancer, and on breast self-examination, will be
� provided in a variety of settings through group and/or individual
sessions and printed materials.
' - Family planning services will be provided to American Indian
women, including information/education, referrals, and possibly
' examinations. �
- Free or low cost pregnancy tests will be provided to American
' Indian women in Ramsey County.
� - Referrals and/or service will be provided to ensure that women
receive appropriate cervical cancer screening.
�
� 239
,
�
_ made to acce t �
Contractual arrangements vv�th a provider will be p
referrals and vouchers for subsidized low cost mammography �
screenings for 60 American Indian women.
- Transportation to mammography screenings may be provided to �
ensure that appointments can be kept.
- Follow-up will be conducted to maximize compliance with referrals. �
- Appropriate reimbursement will be secured from Medical �
Assistance and other insurance providers when appropriate and
applicable. ,
- Referrals will be made to Elders and Medicine Men for traditional
healing measures when requested and appropriate. �
Evaluation: '
Subgrantee(s) of the St. Paul Division of Public Health who provide '
components of service to Ramsey County American Indian women
will be required to have an annual contract which identifies specific
performance expectations, service delivery gaals, reporting �
requirements, and quality assurance requirements. Quarterly
reimbursement will be released after receipt of designated reports and �
review of progress toward goals and objectives. Data will be analyzed
in order to assess program effectiveness and make program
changes/modifications as necessary. ,
For the project goal, the following indicators will be evaluated: ,
- �umber of Ramsey County American Indian women provided with
family planning services. r
- number of free pregnancy tests provided to Ramsey County
American Indian women. ,
- number of American Indian women provided with subsidized, low �
240 '
,
,
� cost mammo a h screenin .
� PY g
' - number of Ramsey County American Indian women provided with
education on the importance of cervical and breast cancer
■ screening.
11
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1
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1
' 241
'
'
. . '
Goal 5: To acknowledge and assist in addressing the mental health needs of
the Ramsey County American Indian population. �
Objective SA: �
To increase awareness among the Ramsey County American Indian �
population of existing mental health service providers through 1993.
Objective SB: ,
To assist Ramsey County American Indians in accessing mental health
services by providing referrals and transportation when necessary t
through 1993.
Objective SC:
'
To conduct mental health education for at least 400 Ramsey County ,
American Indians by December 31, 1993.
'
Methods: �
- Referrals will be made to existing community mental health
providers. �
- Transportation may be provided to ensure that persons are able to
access needed mental health services. ,
- Support groups for American Indian persons needing mental health �
support may be established to assist in improving mental health
status.
- Mental health education on topics such as stress and depressio
n will �
be provided in a variety of settings through group and/or ,
individual sessions and printed materials.
- Appropriate reimbursement will be secured from Medical �
242 ,
,
,
, Assistance and other available sources when appropriate.
, - Referrals will be made to Elders and Medicine Men for traditional
healing measures when requested and appropriate.
�
Evaluation:
� Sub rantee s of the St. Paul Division of Public Health who provide
g � )
components of service to Ramsey County American Indian women
' will be required to have an annual contract which identifies specific
performance expectations, service delivery goals, reporting
� requirements, and quality assurance requirements. Quarterly
reimbursement will be released after receipt of designated reports and
review of progress toward goals and objectives. Data will be analyzed
' in order to assess program effectiveness and make program
changes/modifications as needed.
' For this project goal, the following indicators will be evaluated:
' - number of Ramsey County American Indians referred for mental
health services through this project.
� - number of Ramsey County American Indians provided with
transportation to receive mental health services.
, _ erican Indians attendin su ort
number of Ramsey County Am g pp
' groups sessions funded by this project.
- number of Ramsey County American Indians provided with mental
` health education.
,
, .
'
' 243
'
'
'
. �
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(Page Intentionally Left Blank) ,
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. 1
244 ,
,
,
� BUDGET JUSTIFICATION
1992
' 119 647
TOTAL BUDGET REQUESTED: $ ,
�
' A. S�arv and fringe TOTAL: $66,847
' • Registered Nurse _
1 F'TE @ $29,295 29,295
' • Outreach Worker/Health Educator _
1 F'I'E @ $22,920 22,920
' • Secretary = 939
.OS FTE @ $18,787
' • Administrator _
.OS F1'E C $51,030 2,552
' • Fringe Bene�its (20%) includes
life/health insurance, FICA,
unemployment and workers
, , compensation . = 11,141
'
' B. Travel jTrans�ortation TOTAL: $4,440
� • Travel/transportation provided from office/clinic and/or
clients residence to various health providers and locations.
' Patient Transportation:
1,000 miles/month x 12 months @ .25/mile = 3,U44
, Education Outreach Travel:
/
480 miles/month x 12 months @ .25/mile = 1,440
'
' 245
�
'
'
C. �ontracted Services TOTAL: $28,940 '
• Maznmography screening �
30 women @ $70/each screening = 2,100
• Rent for office/clinical services space '
12 months �a $950/month = 11,400
• Physician services for consultation and patient care ,
16 hours/month x 12 months @ $70/hour = 13,440
• Speakers for educational sessions on various topics = 2,�0 ,
,
D. TOTAL: $19,460 �
d Testin ,
• Laboratory Supphes an g
Pregnancy testing $15 /test x 400 tests = 6,000
Cholesterol screening $15 /test x 400 tests = 6,000 ,
Diabetes screening $15 /test x 100 tests � = 1,500
• Outreach/Educational Materials: ,
Purchase of materials for educational presentations. = 800
• Medical Records/Documentation Supplies: ,
Average $50/month x 12 month = 6�
• Miscellaneous (Postage, Printing, Telephone): '
Average �180/month x 12 months = 2,160
• Pharmaceuticals: ,
May include birth control supplies, insulin and
other pharmaceuticals for padent care, ■
average $200/month x 12 months = �4� ■
'
246 �
'
'
, BUDGET JUSTIFICATION
1993
' TOTAL BUDGET REQUESTED: $122,989
'
A. alarv aT nd fringe TOTAL: $70,189
,
' • Registered Nurse _
1 FT'E @ $30,760 30,760
' • Outreach Worker/Health Educator _
1 FTE @ $24,066 24,066
' • Secretary = 986
.OS FI'E @ $19,726
, • Administrator _
.OS FT'E @ $53,582 2,679
' • Fringe Bene�ts (20%) includes
life/health insurance, FICA,
unemployment and workers
tcompensation . = 11,698
�
B. Travel/Transnortation TOTAL: $ 4,440
'
• Travel/transportation provided from office/clinic and/or
, clients residence to various health providers and locations.
Patient Transportation:
, 1,000 miles/month x 12 months @ .21/mile = 3��
' Education/Outreach Travel: _
480 miles/month x 12 months @ .21/mile 1,440
,
' 247
,
,
'
C. C'ontracted Services TOTAL: $ 28,940 ,
• Mammography screening '
30 women @ $70/each screening = 2,100
• Rent for office/clinical services space '
12 months @ $950/month = 11,400
• Physician services for consultation and patient care '
16 hours/month x 12 months @ $70/hour = 13,440
• Speakers for educational sessions on various topics = 2,000 '
,
D. ��plies and Materials TOTAL: $ 19,460
'
• Laboratory Supplies and Testing
Pregnancy testing $15 /test x 400 tests = 6,000 ,
Cholesterol screening $15 /test x 400 tests = 6,000
Diabetes screening $15 /test x 100 tests = 1,500
• Outreach/Educational Materials: �
Purchase of materials for educational presentations. = 800
• Medical Records Documentation Supplies: ,
/
Average $50/month x 12 month = 600
• Miscellaneous Posta e Printin , Tele hone : '
� S � g P )
Average $180/month x 12 months = 2,160
• Pharmaceuticals:
'
May include birth control supplies, insulin and
other pharmaceuticals for padent care, ,
average �200/month x 12 months = 2,400
,
'
248 '
�
' �
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, APPENDIX
,
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' '
CENSUS
OF RAMSEY COUNTY POPULATION BY RACE '
and ETHNIC GROUP, 1990
'
NUMBER OF PERSONS PERCENT DISTRIBUTION
AACE and
BTHWIC GAOUP g�mse� Salot Aam�ey Salot
Conot� Paui Suburb: Couoty Paul Suburbs
AII race:, total............ 485,765 2�2,235 213,530 100.096 100.096 100.096 ,
W61te...................... 427,677 223.947 203.730 88.096 82.396 95.496
B1 a e r...................... 22,674 20,083 2,591 4.796 7.496 1.296
lodlan..................... 4,509 3,697 812 0.996 1.496 0.496 '
A:1 a o...................... 24,792 19,197 5,595 5.196 7.196 2.696
Other...................... 6,113 5,311 802 1.396 2.096 0.496
Ali et6olc �roupa, total.. 485,765 272,235 213,530 100.096 100.096 100.09fo '
Hl:panic.................. 13,890 11,476 2,414 2.9'b 4.296 1.196
Non-Hispanlc............ 471,875 260,759 211,116 97.I96 9S.SRo 98.99fo
,
NOTE: Hi�puric person�ae peesons wla repated Hirp�nic ori`in or dsxca from�Sp�nidr�pekuu countrias r Spin,
Matico.Puato Rico.Q�b�.ad othc eaar�ias of South ad Cm�trsl Amaiu. XlsN�Jc dos na dmote�nce.
}ii�nia may De of any nce,md in the US.Cenas�individua!aelf-idartificuion of r�ce deterenined the raci�l '
atsgory of ncb Hitpuuc.
,
CENSUS OF NON-WHITE POPULATIONS
LIVING IN RAMSEY COUNTY, 1991
Persoas ,
30,000
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